Background: Right lobe (RL) grafts without middle hepatic vein for living donor liver transplantation (LDLT) result in congestion of recipients' livers and sometimes in unfavorable postoperative course. This study aimed to evaluate the feasibility of our new V5-drainage-preserved RL (VP-RL) graft. Methods: Based on a review of 49 donors' livers in a retrospective study using three-dimensional reconstruction-computed tomography volumetry, hepatic vein draining segment 4 (V4) anatomy was classified into three types: inferior V4 dominant (A); superior V4 dominant (B); and umbilical vein to left hepatic vein dominant (C). Differences in functional graft volume (GV) and remnant liver volume (RV) between VP-RL and modified RL (M-RL) grafts with all three types were evaluated. In a prospective study of actual 15 LDLT, the outcome of venous reconstruction and postoperative parameters with VP-RL grafts compared with M-RL grafts was analyzed. Results: In the retrospective study using three-dimensional reconstruction-computed tomography volumetry, in types B and C, functional GV of VP-RL was larger than that of M-RL (P<0.05) without impaired donors' functional RV, whereas functional RV in VP-RL was significantly decreased in type A (P<0.05). In the prospective study of actual 15 LDLT, using VP-RL with types B and C, size and number of venous reconstructions, and functional GV and postoperative parameters, such as postoperative serum total bilirubin levels and ascites volume, were significantly improved compared with those using M-RL (P<0.05). Conclusions: Using preoperative V4 anatomical classification, VP-RL graft procurement is a valuable strategy in RL-LDLT to improve postoperative course of both recipients and donors.
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