Effective anatomic reconstruction of the middle hepatic vein in modified right lobe graft living donor liver transplantation

Introduction. Adult liver transplantation using the right lobe graft without a middle hepatic vein (MHV; modified right lobe graft) has widely been used to compensate for the cadaveric organ shortage. To provide appropriate functional graft volume in the right lobe graft used for living donor liver transplantation (LDLT), successful reconstruction of the MHV is required. We have described herein the effectiveness of an anatomic MHV reconstruction technique with tailoring donor hepatectomy and uniformed MHV reconstruction for modified right lobe grafts. Materials and Methods. From December 2005 to August 2006, 15 adult patients received modified right lobe graft LDLT using a donor hepatectomy technique that exposed the right side of the MHV combined with a bench procedure that reconstructed the modified right lobe graft into the shape of extended right lobe graft, and a modified piggyback anastomosis. Results. A total of 42 V5/V8s were reconstructed with 15 newly formed MHVs. The mean estimated congestion area was 4.2 +/- 2.7% of the total graft volume on computed tomography. The mean pressure gradient between the reconstructed MHV and the recipient inferior vena cava was 2.1 +/- 1.6 mmHg on postoperative day (POD) 7. None of the patients required any procedure for an outflow problem. The patency rates of the reconstructed MHV and its tributaries were 100% (15/15) and 95.2% (40/42), respectively, at POD 30; 100% (15/15) and 73.8% (31/42) at POD 60; and 86.7% (13/15) and 54.8% (23/42) at POD 90. All recipients are currently alive with good liver function. Conclusion. Our procedure seems to be effective for the reconstruction of MHV and its tributaries, and could make modified right lobe graft into the anatomic figure of extended right lobe graft as well as achieve the physiologic advantages of an extended right lobe graft.