Modified right lobe graft with bovine pericardium for middle hepatic vein reconstruction

Modified right lobe graft with middle hepatic vein reconstruction is commonly carried out in living donor liver transplantation these days. Cadaveric vascular graft has been widely used to maintain good outflow in middle hepatic vein tributaries. However, cadaveric donors are limited in Korea. This problem may be compensated with bovine pericardium. From April 2007, we experienced 4 cases of modified right lobe graft living donor liver transplantation using bovine pericardium. After donor hepatectomy, a 2-cm diameter cylinderic shape was made with the large sized bovine pericardium. V5 and V8 (greater than 5mm in diameter) were anastomosed to the bovine pericardium with end-to-side pattern. After reperfusion, it was anastomosed to the recipient's middle and left hepatic vein trunk. All patients recovered well and are currently remaining good liver function (3 to 11 months). Three cases maintain tolerable middle hepatic venous flow and have no congestion of right anterior sector in enhanced computerized tomography or in Doppler ultrasonography. Bovine pericardium can be one of the alternative materials for middle hepatic vein reconstruction of modified right lobe graft in the area of cadaveric organ shortage.