Use of middle hepatic vein in right lobe living donor liver transplantation

Abstract

Summary The harvesting of the middle hepatic vein (MHV) with the right lobe graft for living‐donor liver transplantation allows an optimal venous drainage for the recipient; however, it is an extensive operation for the donor. This is a prospective, nonrandomized study evaluating liver functions and early clinical outcome in donors undergoing right hepatectomy with or without MHV harvesting. From August 2005 to July 2007, a total of 100 donor right hepatectomies were performed with (n = 49) or without (n = 51) the inclusion of the MHV. The decision to take MHV was based on an algorithm that considers various donor and recipient factors. There was no donor mortality in donors in either group. Overall complication rate was higher in MHV (+) donor group, however when remnant liver volume was kept above 30%, complication rates were similar between the groups. The results of this study show that right hepatectomy including the MHV neither affects morbidity nor impairs early liver function in donors when remnant volume is kept above 30%. The decision, therefore, of the extent of right lobe donor hepatectomy should be tailored to the particular conditions considering the graft quality and metabolic demand of the recipient.

Risk of venous congestion in live donors of extended right liver graft

“…Although a RV/TLV of at least 30%-35% is usually required to avoid small-for-size syndrome (SFSS) [1,4,8] , successful outcomes with RV/TLV < 30% have been reported in the setting of optimal liver quality [6,7,11,24] . Inclusion of the MHV with right grafts, which has been reported to optimize graft function [1,4,7,25] but to potentially impair remnant recovery [1,[26][27][28] , has both …”

“…Inclusion of the MHV with right grafts, which has been reported to optimize graft function [1,4,7,25] but to potentially impair remnant recovery [1,[26][27][28] , has both …”

“…supporters and detractors [2,7,8,27,[29][30][31][32][33][34] . Currently, many centres encourage a selective MHV management policy based on individual graft/remnant characteristics [4,7,12] .…”

“…The occurrence of small-for-size syndrome (SFSS) in donors as a result of inadequate functional remnant volume is a constant reminder of the controversy surrounding venous congestion and MHV management. The commonly accepted definitions for small-for-size-(SFS)-remnants do not even consider remnant volume values [4,[6][7][8][9][10][11] . To date, there are no published reports correlating the extent of functional impairment and parenchymal congestion in non-MHV containing remnants, and remnant volume limits for safe MHV inclusion with the right graft are still undefined.…”

“…We finally considered "reasonable" criteria for procurement of right grafts with/without complete MHV vs selective MHV-4A preservation in remnants based both on our own experience with donors without evidence of steatosis as well as on that of others [4,[6][7][8][11][12][13][14][15][16] .…”