Summary
Living donor liver transplantation (LDLT) is a curative treatment for end stage liver disease. It is advantageous due to the shortage of deceased donors. However, in LDLT, whether the middle hepatic vein (MHV) should be preserved in donors remains controversial. We conducted searches in Pubmed, Embase, Cochrane Library, Web of Science, Ovid, and Google Scholar using the key words “living donor liver transplantation” and “middle hepatic vein”. Due to ethical issues, there were no randomized control trails focusing on MHV in LDLT. The majority of reports were retrospective studies. We examined the reference lists to identify related investigations. Google Scholar was then used to obtain full texts. Nine observational studies were analyzed. There were no significant differences in liver function (WMD, −5.51; P=0.12) and complications (RR, 0.98; P=0.89) in donors with or without MHV. However, the liver function in recipients was greatly improved after LDLT with MHV (WMD, −78.32; P=0.01). No definite conclusion was obtained in terms of the liver regeneration indices between LDLT with or without MHV. It was conclude that grafts with MHV in LDLT favor recipient outcomes and do not harm the living donor if a careful preoperative evaluation is performed.
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References
Starzl TE, Marchioro TL, Vonkaulla KN, et al. Homotransplantation of the liver in humans. Surg Gynecol Obstet, 1963,117:659–676
Raia S, Nery JR, Mies S. Liver transplantation from live donors. Lancet, 1989,2(8661):497
Zhijun Z, Wei G, Lin W, et al. Middle hepatic vein allocation in adult right lobe living donor liver transplantation. Clin Transplant, 2014,28(10):1194–1201
Lee SG. A complete treatment of adult living donor liver transplantation: A review of surgical technique and current challenges to expand indication of patients. Am J Transplant, 2015,15(1):17–38
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, 2014,38(11):2927–2933
Inomata Y, Tanaka K, Uemoto S, et al. Living donor liver transplantation: an 8-year experience with 379 consecutive cases. Transplant Proc, 1999, 31(1–2):381
Inomata Y, Uemoto S, Asonuma K, et al. Right lobe graft in living donor liver transplantation. Transplantation, 2000,69(2):258–264
Lai CY, Han SM, Chen YJ, et al. Venous outflow reconstruction using an expanded polytetrafluoroethylene vascular graft in living-donor liver transplant: a single-center experience. Exp Clin Transplant, 2014,12(3):241–245
Kim JD, Choi DL, Han YS. Simplified one-orifice venoplasty for middle hepatic vein reconstruction in adult living donor liver transplantation using right lobe grafts. Clin Transplant, 2014,28(5):561–568
Zhang S, Dong Z, Zhang M, et al. Right lobe living-donor liver transplantation with or without middle hepatic vein: a meta-analysis. Transplant Proc, 2011,43(10):3773–3779
Yu PF, Wu J, Zheng SS. Management of the middle hepatic vein and its tributaries in right lobe living donor liver transplantation. Hepatobiliary Pancreat Dis Int, 2007,6(4):358–363
Tojimbara T, Fuchinoue S, Nakajima I, et al. Analysis of postoperative liver function of donors in living-related liver transplantation: comparison of the type of donor hepatectomy. Transplantation, 1998,66(8):1035–1039
Akbulut S, Yilmaz M, Eris C, et al. Living-donor liver transplant using the right hepatic lobe without the right hepatic vein: solving the drainage problem. Exp Clin Transplant, 2013,11(3):278–282
de Villa VH, Chen CL, Chen YS, et al. Right lobe living donor liver transplantation-addressing the middle hepatic vein controversy. Ann Surg, 2003,238(2):275–282
Cattral MS, Molinari M, Vollmer CM Jr., et al. Living-donor right hepatectomy with or without inclusion of middle hepatic vein: comparison of morbidity and outcome in 56 patients. Am J Transplant, 2004,4(5):751–757
Hata S, Sugawara Y, Kishi Y, et al. Volume regeneration after right liver donation. Liver Transpl, 2004,10(1):65–70
Scatton O, Belghiti J, Dondero F, et al. Harvesting the middle hepatic vein with a right hepatectomy does not increase the risk for the donor. Liver Transpl, 2004,10(1):71–76
Cho EH, Suh KS, Lee HW, et al. Safety of modified extended right hepatectomy in living liver donors. Transpl Int, 2007,20(9):779–783
Zhu ZJ, Hou JC, Zhang YM, et al. Middle hepatic treatment algorithm in right lobe living donor liver transplantation for donor recipient safety. Zhonghua Yi Xue Za Zhi (Chinese), 2009,89(26):1825–1829
Dayangac M, Taner CB, Balci D, et al. Use of middle hepatic vein in right lobe living donor liver transplantation. Transpl Int, 2010,23(3):285–291
Mancero JM, Gonzalez AM, Ribeiro MA Jr., et al. Living donor right liver lobe transplantation with or without inclusion of the middle hepatic vein: analysis of complications. World J Surg, 2011,35(2):403–408
Chen HL, Tsang LL, Concejero AM, et al. Segmental regeneration in right-lobe liver grafts in adult living donor liver transplant. Clin Transplant, 2012,26(5):694–698
Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet, 1999,354(9193):1896–1900
Olthoff KM, Emond JC, Shearon TH, et al. Liver regeneration after living donor transplantation: Adult-toadult living donor liver transplantation cohort study. Liver Transpl, 2015,21(1):79–88
Lim WX, Cheng YF, Huang TL, et al. Graft regeneration in pediatric living donor liver transplantation. Transplant Proc, 2014,46(3):767–769
Marcos A, Fisher RA, Ham JM, et al. Liver regeneration and function in donor and recipient after right lobe adult to adult living donor liver transplantation. Transplantation, 2000,69(7):1375–1379
Uchiyama H, Shirabe K, Nakagawara H,et al. Revisiting the safety of living liver donors by reassessing 441 donor hepatectomies: is a larger hepatectomy complicationprone? Am J Transplant, 2014,14(2):367–374
Chen P, Wang W, Yan L, et al. Reconstructing middle hepatic vein tributaries in right-lobe living donor liver transplantation. Dig Surg, 2014,31(3):210–218
Rosenkrantz AB, Block TK, Hindman N, et al. Combination of increased flip angle, radial k-space trajectory, and free breathing acquisition for improved detection of a biliary variant at living donor liver transplant evaluation using gadoxetic acid-enhanced MRCP. J Comput Assist Tomogr, 2014,38(2):277–280
Seehofer D, Eurich D, Veltzke-Schlieker W, et al. Biliary complications after liver transplantation: old problems and new challenges. Am J Transplant, 2013,13(2):253–265
Ragab A, Lopez-Soler RI, Oto A, et al. Correlation between 3D-MRCP and intra-operative findings in right liver donors. Hepatobiliary Surg Nutr, 2013,2(1):7–13
Limanond P, Raman SS, Ghobrial RM, et al. The utility of MRCP in preoperative mapping of biliary anatomy in adult-to-adult living related liver transplant donors. J Magn Reson Imaging, 2004,19(2):209–215
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Yi, Ps., Zhang, M. & Xu, Mq. Management of the middle hepatic vein in right lobe living donor liver transplantation: A meta-analysis. J. Huazhong Univ. Sci. Technol. [Med. Sci.] 35, 600–605 (2015). https://doi.org/10.1007/s11596-015-1477-3
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DOI: https://doi.org/10.1007/s11596-015-1477-3