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

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.