Anterior Segment Congestion of a Right Liver Lobe Graft in Living Donor Liver Transplantation and its Strategy to Prevent Congestion

Lee, Sung Gyu; Lee, Young Joo; Park, Kwang Min; Hwang, Shin; Choi, Dong Rak; Kim, Ki Hun; Jeong, Jae Han; Ahn, Chul Soo; Min, Pyung Chul

Abstract

PURPOSE: A left lobe graft from a small donor will not meet the metabolic demands of a larger recipient in adult-to-adult living donor liver transplantation (LDLT). One solution to this problem is to use a right lobe graft. However, the necessity of the middle hepatic vein (MHV) drainage from the anterior segment of a right lobe graft was not yet clearly described in the literatures.
METHODS
From July 1997 to February 1998, five right lobe grafts without having a MHV drainage were implanted in 5 recipients with 2 HBV-cirrhosis, 2 fulminant hepatic failure and 1 secondary biliary cirrhosis. The graft weight ranged from 650 gm to 1000 gm, and their volume ranged from 48% to 83% of the ideal liver mass of the recipients.
RESULTS
Two grafts showed severe congestion of the anterior segment immediately after reperfusion, followed by prolonged massive ascites and severe liver dysfunction in each patient postoperatively. Eventually, one patient died of sepsis on posttransplant 20th day demonstrating progressive hepatic dysfunction.
CONCLUSION
A right lobe graft without having MHV drainage might result in severe congestion of the anterior segment, which was able to lead to the patient's death in an extreme situation. Preservation of the anterior segment venous drainage in the right lobe graft is possible by two harvesting method: an extended right lobe (ERL) graft in which MHV is included in the graft and a modified right lobe (MRL) graft in which venous tributaries of the anterior sement were reconstructed via interposition vein grafts into the recipient's hepatic venous system. Theoretically, in a view point of donor safety, a MRL graft is more advantageous than an ERL graft because MHV is left in the donor liver. Here, we report our experiences of 27 MRL grafts in adult-to-adult LDLTs.