Impact of Multiple Venous Outflow Reconstructions on the Outcome of Adult Living Donor Liver Transplant (LDLT)

Background: Reconstruction of venous outflow is crucial, especially in living donors liver transplantation in the right lobe (RHV, V5, and V8) without the middle hepatic vein.Objective: Our goal is to use a modified right lobe transplant to assess how the numerous venous outflow reconstructions affect the LDLT result.Methods: 39 adult patients who had undergone right lobe ALDLT between January 2021 and February 2024 were included in this prospective cohort research. Using computed tomography (CT) and the software SYNAPS VINCENT (Fujifilm Medical Co.Ltd. Tokyo, Japan), the donor's liver volume was assessed. GRWR for transplanting was ≥0.8%. Segments 5 and 8 of the MHV tributaries' diameters were measured to determine whether reconstruction of more than 5mm or more than 10% of the total graft volume was necessary.Results: We used autologous grafts in 6 patients and synthetic in 18 patients. RHV was used in all patients, V5 was used in 16(41.03%) patients, V8 was used in 5(12.82%) patients, V5+V8 was used in 8(20.51%) patients and RIHV was used in 10(25.64%) patients. The relation between outcome and type of vein graft ( autologous and synthetic) or between the number of grafts(1or2or3or4) of the studied patients, hepatic vein flow, recovery markers, drain amount, hospital stay, ICU stay and mortality were insignificantly different among the groups. Small for size occurred in one patient. Our incidence of mortality was 15%.Conclusion: Reconstruction of V5, V8, or RIHV When the diameter was greater than 5mm or more than 10% of the total graft volume was advised. The lack of vessel grafts with adequate outflow outcomes can be easily addressed using synthetic vessel grafts.