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Background <p>In right-lobe living donor liver transplantation (LDLT) without middle hepatic vein (MHV) inclusion, conventional anastomosis results in poor early patency of MHV tributaries ≤ 5&#xa0;mm, which may cause graft congestion and dysfunction, especially in recipients with marginal graft-to-recipient weight ratio (GRWR). This study evaluated the safety and efficacy of a novel triangular anastomosis for small MHV tributary reconstruction.</p> Methods <p>A single-center, two-period comparative study enrolled 42 adult LDLT recipients (May 2019–December 2025). Period 1 (2019–2023) comprised 24 patients undergoing conventional anastomosis; Period 2 (2023–2025) included 18 patients receiving triangular anastomosis for MHV tributaries ≤ 5&#xa0;mm (standard reconstruction for &gt; 5&#xa0;mm). Primary endpoint was 7-day patency of ≤ 5&#xa0;mm tributaries; secondary endpoints included graft function, complications, and 1-year survival. Patency was analyzed by generalized estimating equations (GEE), and survival by Kaplan–Meier method.</p> Results <p>Baseline and intraoperative characteristics were well balanced. The 7-day patency of ≤ 5&#xa0;mm tributaries was significantly higher in Period 2 (75.0% vs. 26.7%, GEE-adjusted <i>P</i> = 0.032), with no significant 30-day patency difference. Time to total bilirubin normalization was shorter (7.10 ± 3.28 vs. 11.17 ± 3.24 days, <i>P</i> = 0.009). Complication and 1-year survival rates were comparable between groups (both <i>P</i> &gt; 0.05).</p> Conclusions <p>Within the limitations of this small single-center cohort, triangular anastomosis improves early patency of small MHV tributaries and may contribute to earlier graft functional recovery without additional risks. It is a safe and feasible option for high-risk small venous reconstruction in MHV-excluded right-lobe LDLT with marginal GRWR. However, these findings are preliminary, and larger studies with longer follow-up are needed to confirm long-term efficacy.</p>

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Triangular anastomosis enhances early patency of small middle hepatic vein tributaries in right lobe living donor liver transplantation

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月4日

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  • Chi-Yi Chen,
  • Qi-Ming Zheng,
  • Ji-San Sun,
  • Yan Xie,
  • Hong-Hai Wang,
  • Qing-Jun Guo,
  • Li Zhang,
  • Wen-Tao Jiang

摘要

Background

In right-lobe living donor liver transplantation (LDLT) without middle hepatic vein (MHV) inclusion, conventional anastomosis results in poor early patency of MHV tributaries ≤ 5 mm, which may cause graft congestion and dysfunction, especially in recipients with marginal graft-to-recipient weight ratio (GRWR). This study evaluated the safety and efficacy of a novel triangular anastomosis for small MHV tributary reconstruction.

Methods

A single-center, two-period comparative study enrolled 42 adult LDLT recipients (May 2019–December 2025). Period 1 (2019–2023) comprised 24 patients undergoing conventional anastomosis; Period 2 (2023–2025) included 18 patients receiving triangular anastomosis for MHV tributaries ≤ 5 mm (standard reconstruction for > 5 mm). Primary endpoint was 7-day patency of ≤ 5 mm tributaries; secondary endpoints included graft function, complications, and 1-year survival. Patency was analyzed by generalized estimating equations (GEE), and survival by Kaplan–Meier method.

Results

Baseline and intraoperative characteristics were well balanced. The 7-day patency of ≤ 5 mm tributaries was significantly higher in Period 2 (75.0% vs. 26.7%, GEE-adjusted P = 0.032), with no significant 30-day patency difference. Time to total bilirubin normalization was shorter (7.10 ± 3.28 vs. 11.17 ± 3.24 days, P = 0.009). Complication and 1-year survival rates were comparable between groups (both P > 0.05).

Conclusions

Within the limitations of this small single-center cohort, triangular anastomosis improves early patency of small MHV tributaries and may contribute to earlier graft functional recovery without additional risks. It is a safe and feasible option for high-risk small venous reconstruction in MHV-excluded right-lobe LDLT with marginal GRWR. However, these findings are preliminary, and larger studies with longer follow-up are needed to confirm long-term efficacy.