Feasibility and Safety for Using Recipient's Middle Hepatic Vein for Drainage of the Right Paramedian Sector in Right Liver Graft

Abstract

We reported that the use of the recipient's native middle hepatic vein (MHV) trunk for the reconstruction of MHV tributaries is a feasible and valuable surgical strategy in right liver living donor liver transplantation (LDLT), because the use of this MHV trunk does not require additional surgeries for both the donor and recipient (1). However, Ikegami et al. (2) asserted that in-site transection of a liver with hepatocellular carcinomas (HCCs) for obtaining the MHV carried the risk of disseminating HCCs in a recipient because of incomplete accuracy of the pretransplant radiological imaging. In order not to encounter HCC recurrence after transplantation, we have considered cases where the HCC lesion is located 2 cm away from the MHV trunk and not on the ventral side of the MHV trunk as the indication of obtaining the recipient's native MHV trunk. Until July 2008, we performed the reconstruction of the MHV tributaries of the liver graft by obtaining the recipient's MHV trunk in a total of 25 patients with HCC according to these strict criteria. Of the 25 HCC patients in whom the recipient's MHV trunk was used to reconstruct the MHV tributaries of the liver graft, no recurrence of HCC has been observed except one patient in whom the HCC ruptured before the LDLT surgery with a median follow-up of 18 months (6–34 months). Ikegami et al. (2) also suggested that the reconstruction of an accessory hepatic vein in site after reperfusion might be troublesome with the increase the risk of bleeding (2). However, we demonstrated (1) that the operative bleeding and ischemic time were not significant greater in patients with the reconstructed MHV tributaries than in those without reconstructed MHV tributaries. The mean operative bleeding of LDLT with and without the reconstruction of the MHV tributaries were 3954 and 5150 mL, respectively. Judging from our results, we consider our strategy as a clinically acceptable option. Longer-term follow-up is needed to ascertain the feasibility and safety of the in-site transection of a liver with HCC for obtaining the MHV. Hirotaka Tashiro Toshiyuki Itamoto Hironobu Amano Akihiko Oshita Tsuyoshi Kobayashi Kentaro Ide Toshimasa Asahara Hideki Ohdan Second Department of Surgery Hiroshima University Hospital Hiroshima, Japan