A Feasible Technique for Middle Hepatic Vein Reconstruction in Right Lobe Liver Transplantation: Usage of Autologous Portal Vein With Bench Recanalized Umbilical Vein Graft.

Abstract

Background Middle hepatic vein (MHV) reconstruction is necessary to achieve a good outcome in right lobe liver transplantation. Many successful reconstruction methods have been reported as there are anatomical variations in MHV tributaries. Some methods are time consuming to perform routinely and other methods are not applicable in all anatomical variations. Large series which describe routine use of portal vein (PV) and bench recanalized umbilical vein (UV) graft have not been reported. In this paper, we report our experience of this novel technique of MHV reconstruction as a standard protocol. Material and method From February 2017 to December 2018, there were 301 patients who received right lobe liver transplant in our Centre, and the new MHV in 268 grafts were reconstructed with autologous PV and bench recanalized UV. The length of the vein graft and distance between segment 5 branch and MHV orifice were measured. We divided these patients into 3 risk groups according to the MHV drainage area (congestion volume) of the right lobe (Low risk: under 30%, Medium risk: 31 to 45%, High risk: over 45%). Clinical data was collected, and perioperative data were compared between the 3 groups. Results The distance from V5 to MHV orifice, PV autologous graft only, and PV&UV was 9.5±2.5, 7.2±1.5, 13.5±2.2 cm respectively. The patency rate of our reconstructed MHV was 97% and 89% at 1 month and 1 year respectively. There was no significant difference in perioperative data among the 3 groups. The survival in medium and high groups were statistically equivalent to that in low risk group. Conclusion Autologous portal with bench recanalized umbilical vein graft shows a high patency rate and achieves satisfactory outcome in grafts with large MHV drainage area. This graft is able to deal with all the MHV tributary variations by a single method.