title: Emergency re-routing of anterior sector venous outflow for right lobe living donor liver transplantation including the middle hepatic vein.
abstract: BACKGROUND
  Controversy remains over whether the middle hepatic vein should be included in the liver graft in right liver living donor liver transplantation. Congestion in the anterior sector of a right liver graft can cause graft malfunction, which is especially devastating in the case of a graft with marginal size in relation to recipient body size on top of poor pre-transplant recipient status. The case we report here highlighted the importance of the middle hepatic vein in right liver living donor liver transplantation.
  
  
  METHODS
  We illustrated the rectification of outflow obstruction of the middle hepatic vein in the anterior sector of right liver graft caused by technical error during transplantation. The rectification was performed with emergency re-routing using an artificial conduit.
  
  
  RESULTS
  Congestion in the anterior sector of the graft improved immediately and the patient's postoperative liver function test results improved gradually.
  
  
  CONCLUSIONS
  The middle hepatic vein is important for effective drainage of the anterior sector of a right liver graft. The re-routing technique described in the report can also be applied to cases in which the middle hepatic vein is injured during hepatectomy requiring immediate reconstruction.
authors.affiliation: Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
authors.forename: Kenneth S H
authors.initials: KS
authors.lastname: Chok
authors.forename: See Ching
authors.initials: SC
authors.lastname: Chan
authors.forename: Chung Mau
authors.initials: CM
authors.lastname: Lo
authors.forename: Sheung Tat
authors.initials: ST
authors.lastname: Fan
mesh_terms: D019917:Blood Vessel Prosthesis Implantation; D004630:Emergencies; D058625:End Stage Liver Disease / Q000601:surgery* / Q000821:virology; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019694:Hepatitis B, Chronic / Q000150:complications; D006801:Humans; D008102:Liver Circulation; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery