Middle hepatic vein reconstruction in adult right lobe living donor liver transplantation improves recipient survival

摘要

Background:The efficacy and necessity of middle hepatic vein (MHV) reconstruction in adult-to-adult right lobe living donor liver transplantation (LDLT) remain controversial.The present study aimed to evaluate the survival beneficiary of MHV reconstructions in LDLT.Methods:We compared the clinical outcomes of liver recipients with MHV reconstruction (n =101) and without MHV reconstruction (n=43) who underwent LDLT using right lobe grafts at our institution from January 2006 to May 2017.Results:The overall survival (OS) rate of recipients with MHV reconstruction was significantly higher than that of those without MHV reconstruction in liver transplantation (P=0.022;5-yr OS:76.2％ vs 58.1％).The survival of two segments (segments 5 and 8) hepatic vein reconstruction was better than that of the only one segment (segment 5 or segment 8) hepatic vein reconstruction (P=0.034;5-yr OS:83.6％ vs 67.4％).The survival of using two straight vascular reconstructions was better than that using Y-shaped vascular reconstruction in liver transplantation with two segments hepatic vein reconstruction (P=0.020;5-yr OS:100％ vs 75.0％).The multivariate analysis demonstrated that MHV tributary reconstructions were an independent beneficiary prognostic factor for OS (hazard ratio=0.519,95％ CI:0.282-0.954,P=0.035).Biliary complications were significantly increased in recipients with MHV reconstruction (28.7％ vs 11.6％,P =0.027).Conclusions:MHV reconstruction ensured excellent outflow drainage and favored recipient outcome.The MHV tributaries (segments 5 and 8) should be reconstructed as much as possible to enlarge the hepatic vein anastomosis and reduce congestion.