Portal vein complication and technical refinement after live donor right hepatectomy

Background: This study intended to assess incidence, risk factors and treatment of PV complication after living donor right hepatectomy (LDRH). Methods: This study analyzed 2979 cases of LDRH from July 1997 to December 2014 at Asan Medical Center regarding on PV complication. Results: Male and female were 2055 (69.0%) and 924 (31.0%), respectively. Mean donor age was 27.5 ± 8.1 years old. Mean body mass index was 22.70 ± 2.70. Type 1, 2, 3, and other PV anomalies were 2727 (91.6%), 113 (3.8%), 132 (4.4%), and 6 (0.2%), respectively. PV stenosis (>50% narrowing of PV diameter) occurred 47 cases (1.5%). PV reconstruction (odds ratio 7.949; p=0.012), anomalous PV anatomy (OR 4.536; p< 0.001), acute angulation between main and Left PV (60-90 OR 2.214; p=0.041, < 60 OR 7.690; p< 0.001), and no fixation of falciform ligament (OR 2.213; p=0.010) were significant risk factors for PV stenosis. Among 47 PV stenosis donors, PV stent insertion was performed in 9 cases (0.3%) which occurred 1 in type 1 (0.1%), 2 in type 2 (1.8%), 6 in type 3 (4.5%), and 0 in other types (P< 0.001). All PV complication donors had no long-term sequelae. Conclusions: PV reconstruction and no fixation of falciform ligament should be avoided to prevent PV complication during LDRH. Because donors with anomalous PV anatomy or acute angulation between main and left PV have a higher tendency to occur PV complication after LDRH, those donors require meticulous surgical techniques during operation and periodic image studies after operation.