[Middle hepatic treatment algorithm in right lobe living donor liver transplantation for donor recipient safety]

The treatment algorithm of donor middle hepatic vein (MHV) was made depending on the remnant liver volume of the total donor liver volume as calculated by computer tomography, estimated graft-to-recipient weight ratio and also anatomy. The present study was to analyze the influence of this algorithm upon the safety of donors and recipients in right lobe living donor liver transplantation (LDLT) and to provide references for our future clinical practices.

Data of 73 consecutive LDLT cases, operated and managed by the same surgical team according to the pre-operation MHV treatment algorithm, were analyzed. MHV was harvested in 28 cases and not in 45 cases. Donor and recipient gender, age, weight, operation time, blood loss volume, graft weight, non-hepatic phase, graft cold preservation time, perioperative survival rate and the incidence of small-for-size syndrome were compared, and also the peak post-operative values of ALT, AST, T-bilirubin and D-bilirubin.

No donor needed blood transfusion and suffered small-for-size syndrome. One recipient recovered from small-for-size syndrome successfully by medical interventions. One recipient had acute hepatic necrosis at Day 6 post-operation and was converted into cadaveric liver transplantation. At Day 30 post-operation, one recipient died from disseminated infections and respiratory failure, but his liver function was normal. There was significant difference in donor and recipient age, actual GRWR, graft cold preservation time and recipient's ALT peak value between the MHV harvest group and the MHV non-harvest group.

The MHV treatment algorithm is safe to both donors and recipients.