Congestion of right liver graft in living: Donor liver transplantation

Background. Left liver graft from a small donor will not meet the metabolic demands of a larger adult recipient. One solution to this problem is to us e a right liver graft without a middle hepatic vein (MHV). However, the nee d for drainage from the MHV tributaries has not yet been described. Methods. Five right liver grafts without a MHV were transplanted in patient s including two hepatitis B virus-cirrhosis, two fulminant hepatic failure and one secondary biliary cirrhosis, The graft weight ranged from 650 to 10 00 g, corresponding to 48 to 83% of the standard liver volume of the recipi ents. Results. Two of five recipients were complicated with severe congestion of the right median sector immediately after reperfusion, followed by prolonge d massive ascites and severe liver dysfunction. One of the patients died of sepsis with progressive hepatic dysfunction 20 days after the operation. Conclusions. Preservation and reconstruction of the MHV tributaries is reco mmended to prevent congestion of the right liver graft without MHV.