The importance of Inferior Hepatic vein reconstruction in right lobe liver grafts: Does it really matter?

Abstract Background Reconstruction of large IHV is mandatory to preserve graft outflow. However, outcome of small IHV reconstruction is not known as they often get blocked postoperatively. We therefore retrospectively analysed the role of IHV reconstruction and compared outcome of smaller IHV to ascertain role in graft alignment and improving graft outflow. Methods All patients receiving RLG from January,2014 to September,2019 were reviewed. Patients were classified in two groups-grafts without IHV reconstruction(Group RV) and with IHV reconstruction(Group IRV). Small IHVs were compared between two group according to their postoperative patency. Results There was no difference between two groups (Group IRV, n = 430, Group RV, n = 795) in pre/intra-operative variables except ischemia times. However, Clavien Dindo grade 3 complications, RHV occlusion and mortality were significantly higher in group RV. 55.1% of small IHVs were blocked in the postoperative period. However, there was no difference in outcome between blocked and patent IHVs. Conclusion Outcome of liver grafts with IHV reconstruction was better than those without IHV reconstruction. RHV occlusion was also significantly lower with IHV reconstruction which may explain the role of better positioning of the graft and preventing outflow obstruction. IHVs should preferably always be reconstructed and even they get blocked may improve overall outcome by maintaining graft in true orthotopic position.