Reconstruction of the Middle Hepatic Vein in Right Lobe Living Donor Liver Transplantation: The Experience at Ajou University Hospital

ABSTRACT

Reconstruction of the middle hepatic vein (MHV) tributaries, in modified right lobe grafts, appears to be effective for solving the congestion problem of the right paramedian sector (segment V, VIII). Various methods have been proposed to maintain efficient graft outflow for right lobe grafts without the middle MHV by centers with a high volume of procedures. Since December 2005, we adopted the bench procedure for reconstruction of a modified right lobe graft into the shape of an extended right lobe graft with a venous pouch to form a common trunk between the MHV (or newly reconstructed MVH) and right hepatic vein (RHV) using a cryoperserved aortic patch or bovine pericardium. Before December 2005, the graft RHV and MVH were anastomosed to the recipients' RHV and MHV/left hepatic vein. In this study, we compared the results of these two different methods (23 recipients of the direct and separate anastomosis, group A; 40 recipients of formation of a common outflow trunk, group B). The two groups were comparable in terms of preoperative parameters. Compared with group A, the middle hepatic vein patency length in group B was much better (p = 0.000). The necessity of metallic stenting due to early occlusion of the hepatic vein was significantly decreased in Group B (Group A; 5/21 vs. Group B; 2/40, p = 0.042). However, 1-year patient and graft survival was not different between the two groups (p = 1.000). Our procedure for constructing a modified right lobe graft into an anatomical figure with the extension of the right lobe graft and reconstruction of a wider outflow tract might provide an effective functioning liver mass and help to improve the outcomes in these patients.