title: Clinical strategy for the reconstruction of middle hepatic vein tributaries in right liver living donor liver transplantation.
abstract: BACKGROUND
  Venous drainage of the right paramedian sector (segments V and VIII), which is mainly via the middle hepatic vein (MHV), remains the major concern when using a right liver graft in living donor liver transplantation (LDLT). We herein describe our approach to decision making in the reconstruction of MHV tributaries in LDLT using a right liver graft without the MHV trunk.
  
  
  METHODS
  A total of 77 consecutive right liver LDLTs were performed between January 2011 and December 2012. The MHV trunk was not taken with the graft, and all MHV tributaries were ligated during donor hepatectomy. The right liver graft was subsequently assessed on the back table for congestion in the right paramedian sector as an indicator for the need to reconstruct MHV tributaries.
  
  
  RESULTS
  Based on the algorithm, reconstruction of MHV tributaries was performed in 18 patients (23.4 %). Although a mild degree of congestion in the right paramedian sector was noted in a few liver grafts without venous reconstruction, this congestion was well tolerated by recipients and was not visible afterward. The recipients' outcomes were similar in groups with and without venous reconstruction, and the 1-year survival rates were 83.3 and 86.2 %, respectively.
  
  
  CONCLUSIONS
  A right liver graft without the MHV trunk can be successfully performed in LDLT with a satisfactory outcome. However, these experiences show that this approach might be safely applied as a strategy for determining the necessity of reconstruction of MHV tributaries in a right liver graft without the MHV trunk in LDLT.
authors: Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kwei-Shan Township, Taoyuan, 33305, Taiwan, chankunming@adm.cgmh.org.tw.
authors: Kun-Ming
authors: KM
authors: Chan
authors: Chih-Hsien
authors: CH
authors: Cheng
authors: Tsung-Han
authors: TH
authors: Wu
authors: Ting-Jung
authors: TJ
authors: Wu
authors: Hong-Shiue
authors: HS
authors: Chou
authors: Ching-Sung
authors: CS
authors: Lee
authors: Wei-Chen
authors: WC
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006503:Hepatic Veins / Q000033:anatomy & histology / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000098:blood supply; D008102:Liver Circulation; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D020858:Tissue and Organ Harvesting