title: Graft harvest of right posterior segment for living-donor liver transplantation.
abstract: BACKGROUND
  Right posterior segmental graft (RPSG) is an alternative procedure for living-donor liver transplantation (LDLT). Although the first case of RPSG was reported in 2001, it has not been disseminated because of the lack of popularity, technical concerns, and surgical difficulties.
  
  
  METHODS
  A 37-year-old man with primary sclerosing cholangitis. His spouse was the only transplantation candidate, although she was ABO incompatible. Preoperative investigations revealed that left-lobe graft was insufficient for the recipient and that right-lobe graft was accompanied by donor risk. In RPSG, estimated graft-to-recipient weight ratio (GRWR) and estimated ratio of liver remnant were reasonable. In the donor operation, the right hepatic vein (RHV) and demarcation line were confirmed, and intraoperative cholangiography was performed. The cut line was carefully considered based on the demarcation line and RHV. The RPSG was harvested. Actual GRWR was 0.54. Unfortunately, this recipient showed a poor course and outcome after LDLT.
  
  
  CONCLUSIONS
  Segmental branches of vessels and biliary duct may be not suitable for reconstruction, and surgeons must exercise some ingenuity in the recipient operation. Segmental territory based on inflow and that based on outflow never overlap completely, even in the same segment. The selection of RPSG based only on liver volume may be unfeasible. Liver resection should be carefully considered based on preoperative imaging, and demarcation line and RHV during surgery.
  
  
  CONCLUSIONS
  RPSG is a useful tool for LDLT. However, detailed studies before surgery and careful consideration during surgery are important for RPSG harvest.
authors.affiliation: Department of Transplant Surgery, Kyoto University Hospital, Kyoto, Japan. Electronic address: horit@kuhp.kyoto-u.ac.jp.
authors.forename: Tomohide
authors.initials: T
authors.lastname: Hori
authors.affiliation: Department of Transplant Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Oike
authors.affiliation: Department of Transplant Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ogura
authors.affiliation: Department of Transplant Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Ogawa
authors.affiliation: Department of Transplant Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
keywords: Liver graft; Liver transplantation; Living donor; Posterior segment