Effects of Middle Hepatic Vein Reconstruction on Right Liver Graft Regeneration

Background: A right liver graft without the middle hepatic vein (MHV) trunk is now commonly used in living-donor liver transplantation for adult patients. The significance of MHV reconstruction on regeneration or functional recovery of right liver grafts after living-donor liver transplantation, however, remains unclear.

Methods: From 2000 to 2002 at the University of Tokyo Hospital in Tokyo, Japan, 56 adult patients received a right liver graft. The patients were divided into three groups by graft type: right liver graft without MHV trunk or MHV reconstruction (n=17); right liver graft without MHV trunk, but with MHV reconstruction (n=27); and extended right liver graft (n=12). Regeneration rate and postoperative liver function were compared among groups. Predictive factors associated with the graft regeneration were identified among clinical variables, including the graft type.

Results: The regeneration rate of the right paramedian sector and the whole graft was lowest in the right liver grafts without the MHV trunk or MHV reconstruction. The regeneration rate of the lateral sector was highest in this type of graft, but the difference was not statistically significant. The factors that significantly correlated with the regeneration rate were preoperative graft volume and graft type. There was no significant difference among groups in any of the liver function parameters.

Conclusions: In the present series, satisfactory outcome was independent of the type of graft used, which indicates that MHV reconstruction should not be omitted routinely but should be performed in selected patients.