BACKGROUND: Controversy remains over whether the middle hepatic vein should be included in the liver graft in right liver living donor liver transplantation. Congestion in the anterior sector of a right liver graft can cause graft malfunction, which is especially devastating in the case of a graft with marginal size in relation to recipient body size on top of poor pre-transplant recipient status. The case we report here highlighted the importance of the middle hepatic vein in right liver living donor liver transplantation.
METHODS: We illustrated the rectification of outflow obstruction of the middle hepatic vein in the anterior sector of right liver graft caused by technical error during transplantation. The rectification was performed with emergency re-routing using an artificial conduit.
RESULT: Congestion in the anterior sector of the graft improved immediately and the patient s postoperative liver function test results improved gradually.
CONCLUSIONS: The middle hepatic vein is important for effective drainage of the anterior sector of a right liver graft. The re-routing technique described in the report can also be applied to cases in which the middle hepatic vein is injured during hepatectomy requiring immediate reconstruction.