Intrahepatic anastomosis formation between the hepatic veins in the graft liver of the living related liver transplantation: Observation by Doppler ultrasonography

In living related Liver transplantation, the right lobe has come to be used as a graft to meet the metabolic demands of adult or adolescent recipients . In harvesting the right lobe as a graft, however, there is controversy as to whether or not the middle hepatic vein (MHV) should be included and rec onstructed. Anatomical intrahepatic anastomosis between the right hepatic v ein (RHV) and MHV is considered to exist, but the formation process of this functional anastomosis has not been demonstrated by Doppler ultrasonograph y (US). In our case, a right lobe including a right branch of the MHV was u sed as a graft. In implanting, the REN was anastomosed to the inferior vena cava and the right branch of the MHV was ligated. Using Doppler US, we che cked the blood flow in the hepatic vein after transplantation. Within 3 day s of surgery, no flow was detected in the right branch of the MHV. A flow a round the right branch of the MHV was observed at postoperative day 6. At p ostoperative day 9, a reverse flow was detected in which the right branch o f the MHV drained into the RHV via the anastomosis between them. Based on o ur results, it appears that a functional intrahepatic anastomosis between h epatic veins formed gradually within 10 days of ligation of an afferent bra nch, during which time the graft function did not deteriorate.