Effectiveness of anatomic reconstruction of the middle hepatic vein in right lobe graft living donor liver transplantation using natural portal vein graft and synthetic graft

Abstract

Background: Living donor liver transplantation (LDLT) using the right lobe is now a standard method for adults to alleviate the problem of graft size insufficiency. Without including middle hepatic vein (MHV) in right lobe graft (RLG) may cause severe congestion in segments V and VIII, which leads to graft dysfunction and septic complications. Objective: This study was conducted to evaluate the efficacy of reconstructing the MHV in RLG LDLT with native portal vein (PV) graft versus synthetic graft. Patients and Methods: This study involved 40 patients eligible for LDLT and was divided into group A, which had synthetic graft reconstruction, and group B, which had native PV graft reconstruction, while controlling for patient characteristics. Results: In our study, 13 (32.5%) cases of postoperative venous graft thrombosis were recorded, with a higher incidence in the synthetic graft group (45.0%) compared with the native PV graft group (20.0%). However, the trend was not statistically significant. Timing-wise, thrombosis was observed earlier in the synthetic graft group. The existence of reconstructed veins V5 and V8 was associated with a higher incidence of thrombosis in the synthetic graft group. Sepsis was also found to be a potential risk factor but with no statistical significance. Conclusion: In adult LDLT with right lobe graft, the native PV graft should be the first choice for MHV reconstruction. The patency rate of the native PV graft was higher than the synthetic graft, especially in cases with multiple veins requiring multiple venous anastomosis, which led to a decreased incidence of thrombosis.