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Clinical Strategy for the Reconstruction of Middle Hepatic Vein Tributaries in Right Liver Living Donor Liver Transplantation

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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.

Conclusion

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.

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Conflict of interest

The authors have declared no conflict of interest.

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Authors and Affiliations

  1. 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

    Kun-Ming Chan, Chih-Hsien Cheng, Tsung-Han Wu, Ting-Jung Wu, Hong-Shiue Chou & Wei-Chen Lee

  2. Department of Gastroenterology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan

    Ching-Sung Lee

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  1. Kun-Ming Chan
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  2. Chih-Hsien Cheng
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  6. Ching-Sung Lee
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Correspondence to Kun-Ming Chan.

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Chan, KM., Cheng, CH., Wu, TH. et al. Clinical Strategy for the Reconstruction of Middle Hepatic Vein Tributaries in Right Liver Living Donor Liver Transplantation. World J Surg 38, 2927–2933 (2014). https://doi.org/10.1007/s00268-014-2667-z

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  • DOI: https://doi.org/10.1007/s00268-014-2667-z

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