Middle hepatic vein reconstruction with a large shunt vessel for right lobe graft in living donor liver transplantation

Abstract

A 58-year-old man diagnosed with non-alcoholic liver cirrhosis and hepatocellular carcinoma (HCC) was referred to our hospital. The Child-Pugh score and the Model for End-stage Liver Disease score were both 8 points. The patient required liver transplantation (LT) to treat his liver cirrhosis and HCC. His son volunteered to be the partial liver donor and living donor (LD). LT using the right lobe graft without the middle hepatic vein (MHV) from the patient’s son was planned. Securing adequate graft-to-recipient body weight ratio and maximizing functional graft volume are important considerations for successful LDLT. The estimated graft volume was 994 cm³, and the congestion area without reconstructing V5 and V8 was 208 cm³ (20.9%) Therefore, it was necessary to create a new MHV to reconstruct the branch of V5 and V8 and connect this to the recipient’s hepatic vein. The distance between V5 and V8 of the graft was estimated as 8.6 cm. The patient had a large shunt vessel from the umbilical vein to the left external iliac vein that was considered suitable for the new MHV. LDLT was performed, and the patency of the new MHV, V5, and V8 was excellent in the early period. The post-operative clinical course was uneventful, and the recipient was discharged on the 28th post-operative day. Seven months after LT, Doppler echography and enhanced CT scan confirmed good patency of the vein graft. Here, we reported a case of LDLT, in which MHV was reconstructed with a large shunt vessel.