Hepatic venous outflow reconstruction in adult right lobe living donor liver transplantation without middle hepatic vein

Background It is difficult and challenging to reconstruct hepatic venous outflow in adult right lobe living donor livertransplantation (LDLT) without the middle hepatic vein (MHV).Excessive perfusion of the portal vein and venous outflowobstruction will lead to acute congestion of the graft,ultimately resulting in primary nonfunction.Although variousreconstruction patterns have been explored in many countries,there is currently no clear consensus.In this study wedescribe a technique to prevent"chocking"of the graft at the outflow anastomosis with the inferior vena cava (IVC) inLDLT using right lobe graft without the MHV.Methods A retrospective analysis was conducted on clinical data from 55 recipients undergoing LDLT using right lobegrafts without the MHV or reconstruction of hepatic venous outflow.The donor’s right hepatic vein (RHV) wasanastomosed with a triangular opening of the recipient IVC;the inferior right hepatic vein (IRHV),if large enough,wasanastomosed directly to the IVC.The great saphenous vein (GSV) was used for reconstruction of significant MHVtributaries.Results No deaths occurred in any of the donors.Of the 55 recipients,complications occurred in 6,including hepaticvein stricture (1 case),small-for-size syndrome (1),hepatic artery thrombosis (1),intestinal bleeding (1),bile leakage (1),left subphrenic abscess and pulmonary infection (1).A total of three patients died,one from small-for-size syndrome andtwo from multiple system organ failure.Conclusions The multiple-opening vertical anastomosis was reconstructed with hepatic vein outflow.This techniquealleviates surgical risk of living donors,ensures excellent venous drainage,and prevents vascular thromboses andprimary nonfunction.