Outflow reconstruction in extended right liver grafts from living donors

The risk of outflow obstruction in extended right liver grafts remains a concern. We developed two procedures to minimize torsion in venous anastomosis and to achieve a short warm ischemic time of the graft. When there were no major short hepatic veins in the graft, a square-shaped vein graft was used to make a single orifice using the middle and right hepatic veins in the graft. When reconstruction of multiple short hepatic veins was necessary, a cryopreserved inferior vena cava graft was used, which was anastomosed with the hepatic veins of the graft ex situ. These techniques were applied in 10 patients with good results without torsion of the hepatic venous reconstruction or other complications. Our new techniques might be useful for recipients of extended right liver grafts to secure nontortuous venous reconstructions with a short warm ischemic time of the graft.