Long-term patency and complications of single orifice hepatic venous outflow reconstruction in right lobe graft living donor liver transplantation: A Vietnamese center experience.

Backgrounds/aims: Reconstruction of hepatic venous outflow is crucial in living donor liver transplantation (LDLT) to prevent graft congestion. This study evaluated the feasibility, long-term patency, complications, and survival rates of single-orifice hepatic venous outflow reconstruction using right lobe grafts.

Methods: A prospective study was conducted involving 52 patients who underwent LDLT with right lobe grafts at 108 Military Central Hospital, Vietnam, from January 2019 to December 2020, with follow-up extending until December 2024. The technique included forming a single triangular orifice by joining the middle hepatic vein (MHV) and right hepatic vein, utilizing extended right lobe grafts with the MHV or modified right lobe grafts where MHV reconstruction was performed using polytetrafluoroethylene grafts. Outcome measures included ultrasound, CT scans, and regular clinical follow-up.

Results: Ten patients (19.3%) required MHV reconstruction. Mean reconstruction time was 17.4 minutes; cold ischemic time averaged 40.9 ± 6.3 minutes. Intraoperative patency was achieved in all cases, with 96.2% showing complete graft perfusion. Five-year patency was 94.2%. MHV complications occurred in three patients (5.8%): two stenoses (3.8%, conservatively managed) and one fatal occlusion (1.9%). Anastomotic diameter ≤ 30 mm significantly increased complication risk (odds ratio [OR] 14.286; 95% confidence interval [CI]: 1.121-183.823; p = 0.011). Five-year survival was 84.6% (95% CI: 75.2%-93.9%), with rates of 100% for cirrhosis, 85.7% for hepatocellular carcinoma, and 58.8% for acute-on-chronic liver failure.

Conclusions: Single-orifice hepatic venous outflow reconstruction is simple, efficient, and reliable in LDLT, achieving high long-term patency and low complication rates without cadaveric grafts.