Anatomy Of The Middle Hepatic Vein: Applications To Living Donor Liver Transplantation

Background/Aims: In living donor liver transplantation, right lobe graft without a middle hepatic vein (MHV) results in potential venous congestion in the anterior segment, while transplantation with MHV represents an important ethical issue from the perspective of donor safety. The present study assessed ramification patterns of the MHV and relationships between hepatic venous drainage of the anterior and medial segments, to plan. optimal harvesting of the right lobe as a graft.Methodology: The authors reviewed 102 patients with normal livers who underwent contrast-enhanced multi-detector row CT.Results: The hepatic vein that drained S4sup (V4sup) joined only the left hepatic vein (LHV) in 60 patients (58%), only the MHV in 25 (25%), and both LHV and MHV in 17 (17%). Both V4sup and the hepatic vein that drained S8 (V8) joined the MHV in 42 patients (42%), and V8 joined proximal to V4sup in 18 of these 42 patients.Conclusions: In donation of a right lobe graft including MHV, preservation of V4sup in the remnant donor liver seems possible in most donors.