A 51-year-old woman underwent right liver donation for her husband, who had a history of hepatitis C, liver cirrhosis, and hepatocellular carcinoma. Her preoperative dynamic computed tomography (CT) revealed that segment VIII was predominantly drained by a tributary of the right hepatic vein (RHV) and segment V by three tributaries (V5) of the middle hepatic vein (MHV). Three-dimensional graphic images created from the CT (Liver Segmentation Simulator, Hitachi Medico Inc., Chiba, Japan) revealed two anastomoses between V5 and the RHV tributaries (Fig. 1). Based on volumetric estimation, the right liver graft corresponded to 52% of the standard liver volume of the recipient. As predicted preoperatively, after transection of the liver parenchyma, congestion of the right paramedian sector was not observed by temporary clamping of the right hepatic artery. Intraoperative Doppler ultrasonography demonstrated regurgitation of venous flow in V5, which drained into the RHV tributary through the anastomosis (Fig. 2). A right liver graft was harvested with the distal portion of the MHV including V5, which communicated with the RHV. No reconstruction of MHV tributraies was performed in the recipient. The postoperative course of the donor and the recipient was uneventful. Doppler ultrasonography consistently revealed hepatopetal portal flow of P5 in the recipient. The V5 was patent on CT 1 and 3 months after transplantation. Kaneko and colleagues1 reported postoperative formation of hepatic venous anastomosis. Sano et al.2 reported that intraoperative Doppler ultrasonography revealed anastomosis of hepatic veins in 24% of living donors. The indication for MHV reconstruction in a right liver graft depends on the anatomy of the MHV tributaries.3 If it is preoperatively known that the MHV tributaries are anastomosed with the RHV, vascular conduits for reconstruction of the MHV tributaries do not need to be prepared.4 Preoperative information regarding communication between the RHV and MHV is important for planning right liver transplantation, and it was provided by thinsliced liver CT and 3-dimensional graphic images of hepatic vein anatomy in this particular case.
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