Effect Of Various Vein Reconstruction In Adult Right Lobe Living Donor Liver Transplantation On Recipient Liver Function Recovery

Background:In adult right lobe living donor liver transplantation (LDLT), management of outflow tract of the middle hepatic vein (MHV) is still a controversial issue. Whether right liver graft should include MHV, necessity of MHV tributaries and inferior right hepatic veins (IRHV) reconstruction in right lobe liver transplantation without MHV, and the meaning of reconstruction of these veins for graft function recovery are controversial and uncertain.Patients and methods:146cases of adult right lobe LDLT without MHV in our center from November2006to December2011were divided into two groups:MHV tributaries or/and IRHV reconstruction (Group I, n=119), neither MHV tributaries nor IRHV reconstruction (Group II, n=27). The119recipients with vein reconstruction were divided into3groups:only one of MHV tributaries (V5or V8) reconstruction (Group A, n=43), only two MHV tributaries (V5and V8) reconstruction (Group B, n=27), V5and V8and IRHV reconstruction (Group C, n=18). Recipient liver function indexes were recorded and analyzed within3weeks after transplantation.Results:The level of TB in Group Ⅱ was significantly higher than that in Group Ⅰ(P <0.05), although the levels of ALT, AST, INR in Group Ⅱ had no significant difference with that of Group Ⅰ, it still had a tendency to be higher than Group Ⅰ. The level of TB in Group B was significantly higher than that in Group A (P<0.05); The value of INR in Group B was higher than that in Group C with a significant difference (P=0.003), and it also had a tendency that the levels of ALT, AST, TB in Group B were higher than that in Group C; Compared to Group C, the levels of ALT, AST, TB in Group A were significantly higher (P=0.013, P=0.004, P=0.000, respectively).Conclusion:The vein reconstruction is meaningful for liver function recovery of the recipients in adult right lobe living donor LDLT without MHV. It is necessary to perfectly reconstruct all the main tributaries of MHV and IRHV, because liver function recovery of the recipients after transplantation will be accelerated with the increase in the number of reconstructed veins.