Management of the middle hepatic vein in right lobe living donor liver transplantation: A meta-analysis

Abstract

Living donor liver transplantation (LDLT) is a curative treatment for end stage liver disease. It is advantageous due to the shortage of deceased donors. However, in LDLT, whether the middle hepatic vein (MHV) should be preserved in donors remains controversial. We conducted searches in Pubmed, Embase, Cochrane Library, Web of Science, Ovid, and Google Scholar using the key words “living donor liver transplantation” and “middle hepatic vein”. Due to ethical issues, there were no randomized control trails focusing on MHV in LDLT. The majority of reports were retrospective studies. We examined the reference lists to identify related investigations. Google Scholar was then used to obtain full texts. Nine observational studies were analyzed. There were no significant differences in liver function (WMD, −5.51; P=0.12) and complications (RR, 0.98; P=0.89) in donors with or without MHV. However, the liver function in recipients was greatly improved after LDLT with MHV (WMD, −78.32; P=0.01). No definite conclusion was obtained in terms of the liver regeneration indices between LDLT with or without MHV. It was conclude that grafts with MHV in LDLT favor recipient outcomes and do not harm the living donor if a careful preoperative evaluation is performed.

Keywords

middle hepatic vein / living donor liver transplantation / donor / recipient

References

[1] StarzlTE, MarchioroTL, VonkaullaKN, et al. . Homotransplantation of the liver in humans. Surg Gynecol Obstet, 1963, 117: 659-676 PMCID: 2634660 PMID: 14100514

[2] RaiaS, NeryJR, MiesS. Liver transplantation from live donors. Lancet, 1989, 2(8661): 497 PMID: 2570198

[3] ZhijunZ, WeiG, LinW, et al. . Middle hepatic vein allocation in adult right lobe living donor liver transplantation. Clin Transplant, 2014, 28(10): 1194-1201 PMID: 25328058

[4] LeeSG. A complete treatment of adult living donor liver transplantation: A review of surgical technique and current challenges to expand indication of patients. Am J Transplant, 2015, 15(1): 17-38 PMID: 25358749

[5] ChanKM, ChengCH, WuTH, et al. . Clinical strategy for the reconstruction of middle hepatic vein tributaries in right liver living donor liver transplantation. World J Surg, 2014, 38(11): 2927-2933 PMID: 24952077

[6] InomataY, TanakaK, UemotoS, et al. . Living donor liver transplantation: an 8-year experience with 379 consecutive cases. Transplant Proc, 1999, 31(1–2): 381 PMID: 10083152

[7] InomataY, UemotoS, AsonumaK, et al. . Right lobe graft in living donor liver transplantation. Transplantation, 2000, 69(2): 258-264 PMID: 10670636

[8] LaiCY, HanSM, ChenYJ, et al. . Venous outflow reconstruction using an expanded polytetrafluoroethylene vascular graft in living-donor liver transplant: a single-center experience. Exp Clin Transplant, 2014, 12(3): 241-245 PMID: 24907726

[9] KimJD, ChoiDL, HanYS. Simplified one-orifice venoplasty for middle hepatic vein reconstruction in adult living donor liver transplantation using right lobe grafts. Clin Transplant, 2014, 28(5): 561-568 PMID: 24628126

[10] ZhangS, DongZ, ZhangM, et al. . Right lobe living-donor liver transplantation with or without middle hepatic vein: a meta-analysis. Transplant Proc, 2011, 43(10): 3773-3779 PMID: 22172845

[11] YuPF, WuJ, ZhengSS. Management of the middle hepatic vein and its tributaries in right lobe living donor liver transplantation. Hepatobiliary Pancreat Dis Int, 2007, 6(4): 358-363 PMID: 17690029

[12] TojimbaraT, FuchinoueS, NakajimaI, et al. . Analysis of postoperative liver function of donors in living-related liver transplantation: comparison of the type of donor hepatectomy. Transplantation, 1998, 66(8): 1035-1039 PMID: 9808488

[13] AkbulutS, YilmazM, ErisC, et al. . Living-donor liver transplant using the right hepatic lobe without the right hepatic vein: solving the drainage problem. Exp Clin Transplant, 2013, 11(3): 278-282 PMID: 23767945

[14] de VillaVH, ChenCL, ChenYS, et al. . Right lobe living donor liver transplantation-addressing the middle hepatic vein controversy. Ann Surg, 2003, 238(2): 275-282 PMCID: 1422691 PMID: 12894022

[15] CattralMS, MolinariM, VollmerCMJr., et al. . Living-donor right hepatectomy with or without inclusion of middle hepatic vein: comparison of morbidity and outcome in 56 patients. Am J Transplant, 2004, 4(5): 751-757 PMID: 15084170

[16] HataS, SugawaraY, KishiY, et al. . Volume regeneration after right liver donation. Liver Transpl, 2004, 10(1): 65-70 PMID: 14755780

[17] ScattonO, BelghitiJ, DonderoF, et al. . Harvesting the middle hepatic vein with a right hepatectomy does not increase the risk for the donor. Liver Transpl, 2004, 10(1): 71-76 PMID: 14755781

[18] ChoEH, SuhKS, LeeHW, et al. . Safety of modified extended right hepatectomy in living liver donors. Transpl Int, 2007, 20(9): 779-783 PMID: 17623050

[19] ZhuZJ, HouJC, ZhangYM, et al. . Middle hepatic treatment algorithm in right lobe living donor liver transplantation for donor recipient safety. Zhonghua Yi Xue Za Zhi (Chinese), 2009, 89(26): 1825-1829

[20] DayangacM, TanerCB, BalciD, et al. . Use of middle hepatic vein in right lobe living donor liver transplantation. Transpl Int, 2010, 23(3): 285-291 PMID: 19821954

[21] ManceroJM, GonzalezAM, RibeiroMAJr., et al. . Living donor right liver lobe transplantation with or without inclusion of the middle hepatic vein: analysis of complications. World J Surg, 2011, 35(2): 403-408 PMID: 21107564

[22] ChenHL, TsangLL, ConcejeroAM, et al. . Segmental regeneration in right-lobe liver grafts in adult living donor liver transplant. Clin Transplant, 2012, 26(5): 694-698 PMID: 22292888

[23] MoherD, CookDJ, EastwoodS, et al. . Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet, 1999, 354(9193): 1896-1900 PMID: 10584742

[24] OlthoffKM, EmondJC, ShearonTH, et al. . Liver regeneration after living donor transplantation: Adult-toadult living donor liver transplantation cohort study. Liver Transpl, 2015, 21(1): 79-88 PMID: 25065488

[25] LimWX, ChengYF, HuangTL, et al. . Graft regeneration in pediatric living donor liver transplantation. Transplant Proc, 2014, 46(3): 767-769 PMID: 24767344

[26] MarcosA, FisherRA, HamJM, et al. . Liver regeneration and function in donor and recipient after right lobe adult to adult living donor liver transplantation. Transplantation, 2000, 69(7): 1375-1379 PMID: 10798757

[27] UchiyamaH, ShirabeK, NakagawaraH, et al. . Revisiting the safety of living liver donors by reassessing 441 donor hepatectomies: is a larger hepatectomy complicationprone. Am J Transplant, 2014, 14(2): 367-374 PMID: 24472194

[28] ChenP, WangW, YanL, et al. . Reconstructing middle hepatic vein tributaries in right-lobe living donor liver transplantation. Dig Surg, 2014, 31(3): 210-218 PMID: 25227957

[29] RosenkrantzAB, BlockTK, HindmanN, et al. . Combination of increased flip angle, radial k-space trajectory, and free breathing acquisition for improved detection of a biliary variant at living donor liver transplant evaluation using gadoxetic acid-enhanced MRCP. J Comput Assist Tomogr, 2014, 38(2): 277-280 PMID: 24625601

[30] SeehoferD, EurichD, Veltzke-SchliekerW, et al. . Biliary complications after liver transplantation: old problems and new challenges. Am J Transplant, 2013, 13(2): 253-265 PMID: 23331505

[31] RagabA, Lopez-SolerRI, OtoA, et al. . Correlation between 3D-MRCP and intra-operative findings in right liver donors. Hepatobiliary Surg Nutr, 2013, 2(1): 7-13 PMCID: 3924642 PMID: 24570909

[32] LimanondP, RamanSS, GhobrialRM, et al. . The utility of MRCP in preoperative mapping of biliary anatomy in adult-to-adult living related liver transplant donors. J Magn Reson Imaging, 2004, 19(2): 209-215 PMID: 14745755