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| Middle hepatic vein reconstruction in adult right lobe living donor liver transplantation improves recipient survival |
| Hai-Jun Guo a , b , Kun Wang a , b , Kang-Chen Chen a , b , Zhi-Kun Liu a , b , Abdulahad Al-Ameri a , b , Yan Shen a , b , Xiao Xu a , b , Shu-Sen Zheng a , b , ∗ |
a Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
b Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
∗ Corresponding author at: Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
E-mail address: zyzss@zju.edu.cn (S.-S. Zheng). |
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Abstract Background: The efficacy and necessity of middle hepatic vein (MHV) reconstruction in adult-to-adult right lobe living donor liver transplantation (LDLT) remain controversial. The present study aimed to eval- uate the survival beneficiary of MHV reconstructions in LDLT.
Methods: We compared the clinical outcomes of liver recipients with MHV reconstruction ( n = 101) and without MHV reconstruction ( n = 43) who underwent LDLT using right lobe grafts at our institution from January 2006 to May 2017.
Results: The overall survival (OS) rate of recipients with MHV reconstruction was significantly higher than that of those without MHV reconstruction in liver transplantation ( P = 0.022; 5-yr OS: 76.2% vs 58.1%). The survival of two segments (segments 5 and 8) hepatic vein reconstruction was better than that of the only one segment (segment 5 or segment 8) hepatic vein reconstruction ( P = 0.034; 5-yr OS: 83.6% vs 67.4%). The survival of using two straight vascular reconstructions was better than that using Y-shaped vascular reconstruction in liver transplantation with two segments hepatic vein reconstruction ( P = 0.020; 5-yr OS: 100% vs 75.0%). The multivariate analysis demonstrated that MHV tributary reconstructions were an independent beneficiary prognostic factor for OS (hazard ratio = 0.519, 95% CI: 0.282–0.954, P = 0.035). Biliary complications were significantly increased in recipients with MHV reconstruction (28.7% vs 11.6%, P = 0.027).
Conclusions: MHV reconstruction ensured excellent outflow drainage and favored recipient outcome. The MHV tributaries (segments 5 and 8) should be reconstructed as much as possible to enlarge the hepatic vein anastomosis and reduce congestion.
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2019, Vol. 18 
