Autologous Recipient Portal Vein Segment For Middle and Right Or Left Hepatic Vein Reconstruction in Living Donor Liver Transplantation: Experience From Erbil, Iraq

Abstract

Background: Adequate hepatic venous outflow is essential for successful living donor liver transplantation (LDLT). Reconstruction of the middle hepatic vein (MHV) and right hepatic vein (RHV) may be required to prevent graft congestion, but the optimal vascular conduit remains uncertain. This study evaluated the feasibility, safety, and clinical outcomes of using an autologous recipient portal vein for hepatic venous reconstruction during LDLT.

Methods: This retrospective observational study included 39 patients who underwent LDLT at Zheen International Hospital, Erbil, Kurdistan Region, Iraq, between January 2012 and March 2026, in whom an autologous recipient portal vein segment was used for MHV and/or RHV reconstruction. Venous graft patency was assessed mainly by Doppler ultrasonography from postoperative Day 1 through 1 year. Early graft function was evaluated using AST, ALT, total bilirubin, INR, and serum creatinine. Early allograft dysfunction (EAD) was defined according to the Olthoff criteria. Vascular complications and patient survival were also assessed.

Results: The mean recipient age was 38.95 ± 16.12 years, and the mean graft-to-recipient weight ratio was 0.89 ± 0.21%. Venous graft patency was 84.6% on Day 1, 91.9% on Day 7, 97.2% at 1 and 3 months, 94.4% at 6 months, and 100% among the 34 patients evaluated at 1 year. AST, ALT, total bilirubin, and INR decreased significantly during the first postoperative week (all P<0.001), while serum creatinine also decreased significantly (P=0.007). EAD occurred in 17 patients (43.6%). Vascular complications occurred in four patients (10.3%), including hepatic vein thrombosis in two (5.1%), hepatic vein stenosis in one (2.6%), and hepatic artery thrombosis in one (2.6%); no portal vein thrombosis was observed. Kaplan-Meier patient survival was 89.7% at 30 days, 90 days, and 1 year.

Conclusion: Autologous recipient portal vein grafts provided high venous patency with acceptable vascular complication rates and favorable short-term patient survival. The technique appears to be a feasible option for MHV and RHV reconstruction in carefully selected LDLT recipients.