Risk factors for inferior right hepatic vein occlusion following right lobe living donor liver transplantation: a single-center experience with 240 cases

Abstract This study aims to analyze the early and long-term outcomes of inferior right hepatic vein (IRHV) reconstruction and identify risk factors associated with IRHV occlusion in right lobe living donor liver transplantations (RL-LDLT). This retrospective cohort study included patients who underwent RL-LDLT with IRHV reconstruction at Institution between January 1, 2021, and December 31, 2023. Data were collected from hospital records, surgical notes, anesthesia records, radiology reports, and patient files. Patients were divided into three groups based on IRHV patency status: patent and early occluded, and late occluded. Preoperative, intraoperative, and postoperative data were analyzed. A total of 204 patients were included in the study. The mean follow-up period was 750.34 ± 364.3 days. IRHV remained patent in 69.61% (n = 142) of patients, whereas 30.39% (n = 62) experienced IRHV occlusion. Early IRHV occlusion (within 30 days) occurred in 52 patients (83.9% of occluded cases). In early occluded cases, the mean IRHV diameter was significantly smaller (4.92 ± 1.61 mm) compared to the open group (6.02 ± 1.72 mm; p < 0.001). ROC analysis identified an IRHV diameter ≤ 5 mm as a cutoff value for predicting occlusion risk (AUC = 0.704; p < 0.001). In long-term follow-up, another 10 patients’ IRHV occluded, late occluded patients were significantly younger (40.63 ± 14.56 vs. 53.21 ± 13.54 years; p = 0.005), had lower body weight (64.30 ± 13.02 vs. 76.55 ± 12.78 kg; p = 0.004), and lower BMI (22.72 ± 3.78 vs. 27.43 ± 4.07 kg/m 2 ; p = 0.001). Additionally, the GWRW ratio was significantly higher in the late occluded group ( p < 0.001), with a mean GWRW ratio of 1.08 ± 0.21 in the open group and 1.43 ± 0.35 in the occluded group. IRHV occlusion was primarily associated with smaller vein diameter (≤ 5 mm) and single anastomosis. This study highlights the need for optimized surgical techniques and perioperative management strategies to enhance IRHV patency, improve graft function, and reduce venous complications in RL-LDLT.