How to Reconstruct Middle Hepatic Vein Branches With Explanted Portal Vein and Inferior Mesenteric Vein Graft: A Case Report

Abstract

ObjectiveThe middle hepatic vein reconstruction is one of the crucial parts in adult living donor liver transplantation. Numerous techniques had been reported by using cadaveric iliac vessel or synthetic graft. The limitations of reported techniques are availability of the vessel and complication of synthetic graft. We report the technique of using explanted portal vein and inferior mesenteric vein graft in sequential fashion. Patients and MethodsThe recipient was a 54-year-old man with chronic hepatitis B cirrhosis and multiple hepatocellular carcinomas. He underwent living donor liver transplantation with modified right lobe graft from spouse. The venous drainages of segments 5 and 8 were reconstructed by explanted left portal vein and inferior mesenteric vein from the donor. The operative time was 9 hours 30 minutes. ResultsThe postoperative course was uneventful. The recipient did not show any signs of small-for-size syndrome such as ascites or hyperbilirubinemia. He recovered well and showed no signs of recurrent disease 1 year after his transplantation. ConclusionThe explanted portal vein graft can be used with another autogenous vein graft such as inferior mesenteric vein for reconstruction of all middle hepatic vein branches.