Fan Sheung-Tat, Lo Chung-Mau, Liu Chi-Leung, Wang Wen-Xi, Wong John
Centre for the Study of Liver Disease and Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
Ann Surg. 2003 Jul;238(1):137-48. doi: 10.1097/01.sla.0000077921.38307.16.
To evaluate the safety of donors who have donated the middle hepatic vein in right lobe live donor liver transplantation (LDLT) and to determine whether such inclusion is necessary for optimum graft function.
The necessity to include the middle hepatic vein in a right lobe graft in adult-to-adult LDLT is controversial. Inclusion of the middle hepatic vein in the graft provides uniform hepatic venous drainage but may lead to congestion of segment IV in the donor.
From 1996 to 2002, 93 right-lobe LDLTs were performed. All right-lobe grafts except 1 contained the middle hepatic vein. In the donor operation, attention was paid to preserve the segment IV hepatic artery and to avoid prolonged rotation of the right lobe. The middle hepatic vein was transected proximal to a major segment IVb hepatic vein whereas possible to preserve the venous drainage in the liver remnant.
There was no donor death. Two donors had intraoperative complications (accidental left hepatic vein occlusion and portal vein thrombosis) and were well after immediate rectification. Twenty-four donors (26%) had postoperative complications, mostly minor wound infection. The postoperative international normalized ratio on day 1 was better in the donors with preservation of segment IVb hepatic vein than those without the preservation, but, in all donors, the liver function was largely normal by postoperative day 7. The first recipient had severe graft congestion as the middle hepatic vein was not reconstructed before reperfusion. In 7 other recipients, the middle hepatic vein was found occluded intraoperatively owing to technical errors. The postoperative hepatic and renal function of the recipients with an occluded or absent middle hepatic vein was worse than those with a patent middle hepatic vein. The hospital mortality rate was also higher in those with an occluded middle hepatic vein (3/9 vs. 5/84, P = 0.028).
Inclusion of the middle hepatic vein in right-lobe LDLT is safe and is essential for optimum graft function and patient survival.
评估在右半肝活体肝移植（LDLT）中捐献肝中静脉的供体的安全性，并确定纳入该静脉对于实现最佳移植物功能是否必要。
在成人对成人的LDLT中，右半肝移植物中纳入肝中静脉的必要性存在争议。将肝中静脉纳入移植物可提供均匀的肝静脉引流，但可能导致供体肝段IV充血。
1996年至2002年期间，共进行了93例右半肝LDLT。除1例之外，所有右半肝移植物均包含肝中静脉。在供体手术中，注意保留肝段IV的肝动脉，并避免右半肝长时间扭转。肝中静脉在肝段IVb主要肝静脉的近端切断，尽可能保留肝剩余部分的静脉引流。
无供体死亡。2例供体出现术中并发症（意外左肝静脉闭塞和门静脉血栓形成），经立即纠正后情况良好。24例供体（26%）出现术后并发症，多数为轻微伤口感染。保留肝段IVb肝静脉的供体术后第1天的国际标准化比值优于未保留者，但所有供体在术后第7天时肝功能基本正常。首例受者因再灌注前未重建肝中静脉而出现严重移植物充血。另外7例受者术中因技术失误发现肝中静脉闭塞。肝中静脉闭塞或缺失的受者术后肝肾功能比肝中静脉通畅的受者差。肝中静脉闭塞者的医院死亡率也更高（3/9对5/84，P = 0.028）。
在右半肝LDLT中纳入肝中静脉是安全的，对于实现最佳移植物功能和患者生存至关重要。
