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Vein Reconstruction in Modified Right Liver Graft for Living Donor Liver Transplantation

Sugawara, Yasuhiko MD; Makuuchi, Masatoshi MD; Sano, Keiji MD; Imamura, Hiroshi MD; Kaneko, Junichi MD; Ohkubo, Takao MD; Matsui, Yuichi MD; Kokudo, Norihiro MD

doi: 10.1097/01.SLA.0000048444.40498.AD
Advances in Surgical Technique

Objective To report the authors’ experience with hepatic vein reconstruction and plasty in living donor liver transplantation for adult patients.

Summary Background Data A right liver graft without the middle hepatic vein (MHV) trunk (modified right liver graft) can cause severe congestion of the right paramedian sector. However, the need for MHV reconstruction has not been fully recognized.

Methods From June 2000 to December 2001, 30 adult patients received a modified right liver graft. Major MHV tributaries were preserved and reconstructed under the authors’ criteria. Plasty of recipient hepatic veins for a wide outflow orifice was performed when necessitated. The regeneration of paramedian and lateral sectors of the grafts was examined by computed tomography 1 and 3 months after the operation.

Results MHV tributaries were reconstructed in 18 grafts. Plasty of recipient hepatic veins was performed in 15 patients. All patients survived the operation. The regeneration of paramedian and lateral sectors was equivalent.

Conclusions A modified right liver graft can provide satisfactory surgical results if hepatic vein reconstruction and plasty are performed using the present techniques.

From the Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

Supported by a Grant-in-aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan, Public Trust Fund for the Promotion of Surgery, Welfide Medical Research Foundation, Mitsui Life Social Welfare Foundation, and a Grant-in-aid for Research on Human Genome, Tissue Engineering, Food Biotechnology, Health Sciences Research Grants, Ministry of Health, Labor and Welfare of Japan

Correspondence: Yasuhiko Sugawara, MD, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.

E-mail: yasusuga-tky@umin.ac.jp

Accepted for publication May 16, 2002.

© 2003 Lippincott Williams & Wilkins, Inc.