Middle Hepatic Vein Tributary Reconstruction of a Right Hepatic Graft in Adult Living Donor Liver Transplantation: A Case Report

Abstract In adult living donor (right liver) lobe transplantations (LDLT), the removal of the middle hepatic vein (MHV) with the graft and reconstruction carried out in the donor are of great importance. Here a 44-year-old male patient with hepatitis B–related end-stage liver failure is reported of whom his 34-year-old brother was evaluated as a donor candidate. At routine preoperative screening tests, neither the patient nor the donor candidate was found to have any pathological findings that might interfere with the transplantation. The donor candidate was assessed using multislice computed tomography for a standard liver volume measurement and anatomical structure evaluation and extended right hepatectomy including MHV was planned. MHV of the donor removed together with the graft was reconstructed to the common orifice of MHV-left hepatic vein using a cryopreserved aortic graft. In conclusion, if the MHV is removed with the graft in adult LDLT, appropriate reconstruction in the donor is also an important issue. Reconstruction carried out without creating tension and folding in the right hepatic vein is crucial for avoiding congestion and of great importance for the prevention of graft dysfunction.