The influence of the middle hepatic vein and its impact on outcomes in right lobe living donor liver transplantation

Abstract Background In adult right lobe living donor liver transplantation, the decision to include the middle hepatic vein (MHV) remains controversial. Methods A retrospective analysis of 50 R-LDLTs between January 2008 and June 2016 was performed. Results Twenty-one procedures were performed using a MHV+ graft (42.0%) and 29 procedures using a MHV- graft (58%). MHV- donors were taller (173 vs 166 cm, p = 0.004) with a larger standard liver volume (1351 vs 1245 mls, p = 0.014) compared to MHV+ donors. The duration of operation for donors was significantly longer in the MHV+ group (530 (313–975) mins) compared to the MHV- group (489 (336–708) mins) (p = 0.029). Similarly, the operative time for recipients was longer in the MHV+ group (660 (428–831) mins) compared to MHV- (579 (359–1214) mins) (p = 0.023). MHV- grafts were heavier compared to MHV+ grafts (918 vs 711 g, p = 0.017). Recipient mortality rates and Kaplan–Meier survival analysis were comparable (p = 0.411). All donors were well at last review. Conclusion Both MHV+ and MHV- grafts are safe for the donor and recipient. The decision to take the MHV should be based on specific donor-recipient characteristics.