Rm. Ghobrial et al., Technical challenges of hepatic venous outflow reconstruction in right lobe adult living donor liver transplantation, LIVER TRANS, 7(6), 2001, pp. 551-555
A right lobe graft that is drained by the right hepatic vein (RHV) is obtai
ned by transecting the liver on the right side of the middle hepatic vein (
MHV). On occasion, a small RHV that only drains a portion of the right lobe
, with the predominant outflow achieved by the MHV, is encountered. If such
variation is not recognized while performing right lobe liver transplantat
ion and the RHV only is used for reconstruction, venous outflow obstruction
with subsequent graft congestion and eventual graft failure will occur. Ad
ditionally, preservation of the main MHV and its branch drainage of the lef
t lobe is crucial to avoid outflow blockage to the remaining segment 4 in t
he donor. We report 4 cases showing a variant type of small RHV and large M
HV branch that drain not only segments 5 and 8, but also segments 6 and 7.
These variations were simultaneously associated with a large-caliber inferi
or RHV that also required reconstruction. The methods used to diagnose such
anatomic variations and the techniques for reconstruction in the donor and
recipient are described.