Hepatic vein reconstruction of the graft in partial liver transplantation from living donor: surgical procedures relating to their anatomic variations

The surgical procedures to reconstruct the hepatic veins differ according to their anatomic variations to obtain the optimal graft volume for the recipient. This is an overview of the procedures used in our 25 living related liver transplantations.The donor/recipient body weight ratio ranged widely from 1.2:1 to 9.6:1 (5.3 +/- 0.5:1, mean +/- SEM).The graft weight/recipient body weight was 2.40% +/- 0.21%. Graft components, which were determined by the optimal graft volume, and their drainage veins were the following: (1) segments 2 and 3 (S2+3) were used in 13 cases, 11 with the left hepatic vein (LHV) and two with the LHV and a partial drainage vein of S3; (2) S2+3 and a part of S4 in eight cases, seven with LHV and one with LHV and a partial drainage vein of S4; (3) S2+3+4 in three cases, with the common trunk of LHV and middle hepatic vein in all cases; and (4) S5+6+7+8 in one case with right hepatic vein. In two of three cases in which the graft had two drainage veins, the two vessels were reformed to have a common anastomotic orifice by the back-table plastic surgery procedure. In the other case in which the procedure could not be performed, two separate anastomoses of the individual vessels were performed successfully. Although stenosis of the reconstructed hepatic veins occurred four times in two cases at 3 months or more after transplantation, all incidences could be completely repaired by balloon dilation.These results show that, with careful consideration of the hepatic vein reconstruction, pediatric patients can receive optimal volume grafts from living donors.