title: Reconstruction of the middle hepatic vein tributary in adult right lobe living donor liver transplantation.
abstract: BACKGROUND
  In adult-to-adult living donor liver transplantation (LDLT), the use of a right lobe graft without the middle hepatic vein (MHV) can cause hepatic congestion and disturbance of venous drainage. To solve this problem, we successfully used cadaveric venous allografts preserved in 4 °C University of Wisconsin (UW) solution within 10 days as interposition veins for drainage of the paramedian portion of the right lobe in adult LDLT.
  
  
  METHODS
  From June 2007 to January 2008, 11 adult LDLT patients received modified right liver grafts. The major MHV tributaries (greater than 5 mm in diameter) of 9 cases were preserved and reconstructed using cadaveric interposition vein allografts that had been stored for 1 to 10 days in 4 °C UW solution. The regeneration of the paramedian sector of the grafts and the patency of the interposition vein allografts were examined by Doppler ultrasonography after the operation.
  
  
  RESULTS
  MHV tributaries were reconstructed in 9 recipients. Only 1 recipient died of renal failure and severe pulmonary infection on day 9 after transplantation without any hemiliver venous outflow obstruction. The other 8 recipients achieved long-term survival with a median follow-up of 30 months. The cumulative patency rates of the 8 recipients were 63.63% (7/11), 45.45% (5/11), 45.45% (5/11) and 36.36% (4/11) at 3, 6, 12 and 24 months, respectively. Regeneration of the paramedian sectors was equivalent.
  
  
  CONCLUSIONS
  The cadaveric venous allograft preserved in 4 °C UW solution within 10 days serves as a useful alternative for interposition veins in facilitating implantation of a right lobe graft and guarantees outflow of the MHV.
authors.affiliation: Division of Liver Transplantation, Department of Organ Transplantation, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
authors.forename: Xiao-Min
authors.initials: XM
authors.lastname: Shi
authors.forename: Yi-Feng
authors.initials: YF
authors.lastname: Tao
authors.forename: Zhi-Ren
authors.initials: ZR
authors.lastname: Fu
authors.forename: Guo-Shan
authors.initials: GS
authors.lastname: Ding
authors.forename: Zheng-Xin
authors.initials: ZX
authors.lastname: Wang
authors.forename: Liang
authors.initials: L
authors.lastname: Xiao
mesh_terms: D000328:Adult; D005500:Follow-Up Studies; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000098:blood supply; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D018608:Ultrasonography, Doppler; D014656:Vascular Surgical Procedures / Q000379:methods*; D055815:Young Adult