Middle hepatic vein allocation in adult right lobe living donor liver transplantation

Abstract

Introduction: When adult-to-adult living donor liver transplantation (LDLT) using the right lobe is carried out, there is disagreement between different centers as to whether the middle hepatic vein (MHV) is included or retained by the donor.

Methods: Ninety-two cases of adult-to-adult LDLT were performed between January 2007 and December 2010 using a right lobe graft. A protocol for MHV allocation was applied according to the donor's remnant liver volume, overall graft/recipient weight ratio (GRWR), and anatomic characteristics of the hepatic vein. Among these cases, there were 44 cases with MHV and 48 cases without MHV. No blood products were used during donor operations, and there was no occurrence of death or small-for-size syndrome after operations.

Results: There were statistical differences between Groups I and II according to the ages of the recipients, the actual GRWR, the weights of grafts, the cold storage time of grafts, etc. All patients recovered smoothly; one-, three-, and five-yr survival rates of patients were 96.7%, 92.4%, and 92.4% and of grafts were 95.7%, 91.3%, and 91.3%, respectively.

Conclusion: With a reasonable allocation protocol and precise evaluation, either MHV harvested or MHV retained to the donor during adult-to-adult LDLT using the right lobe can achieve good outcome.

Keywords: graft/recipient weight ratio; living donor liver transplantation; middle hepatic vein; outcome; remnant liver volume.