الفهرس 
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Abstract
Right lobe living donor liver transplantation (LDLT) is a major development in adult LDLT that has significantly increased the donor pool by providing larger graft size and by decreasing risk of small-for-size graft syndrome. However, right lobe anatomy is complex, not only from the inflow but also from the outflow perspective. Outflow reconstruction is one of the key requirements of a successful LDLT and venous drainage of the liver graft is just as important as hepatic inflow for the integrity of graft function. Outflow complications may cause acute graft failure which is not always easy to diagnose. If the MHV is included in the graft, the walls of the RHV and the MHV can be sutured to form a common outflow channel. However, the use of extended right lobe grafts including MHV has been decreased for the sake of donor safety. For all the liver allografts that are devoid of the MHV, the venous tributaries of segment 5 (V5) and 8 (V8) that are > 4 mm in diameter should be reconstructed. Multiple reconstruction techniques and configurations have been described in the literature for V5 and V8 reconstruction, without clear evidence regarding the best technique regarding its performance and follow-up patency rates. The current study was conducted at Assiut University Hospitals aiming to compare between two different techniques for MHV tributaries reconstruction regarding patency rates after LDLT. We included a total of 40 patients who underwent LDLT. All recipients and donors were evaluated according to our center protocol. The included recipients were divided into two groups according to the configuration of MHV tributaries reconstruction; group A included 22 patients who were reconstructed via an end-to-side fashion, with the proximal end anastomosed with the MHV or MHV/LHV orifice, while group B included the remaining 18 patients who were individually reconstructed in an end-to-end fashion. V5 was connected to the IVC, while V8 was connected to the MHV or MHV/LHV orifice. Our study revealed the following findings: The ages of the included recipients had mean values of 45.91 and 49.78 years in Groups A and B, respectively. Men formed 54.5% of group A participants, whereas they formed 66.7% of group B patients. The remaining portion in both groups was occupied by women. BMI had mean values of 25.53 and 25.77 kg/m2 in the same study groups respectively. The included donors had mean ages of 28.59 and 26.56 years in Groups A and B respectively. There was no significant difference between the study groups regarding the indication for LDLT (p = 0.114). HCV was the most common indication in both study groups (40.9% and 50% of cases in Groups A and B respectively). MELD score a mean value of 18 in group A versus 17.16 in group B. GRWR had a mean value of 1.12 in both study groups. V5 was detected in 90.9% and 88.9% of cases, while V8 was present in 63.6% and 64.7% of patients in the same two groups respectively. For V5, patency was detected in 85% and 56.7% of cases in group A and B respectively at one-week assessment, and that patency rate decreased down to 80%, 50%, 40% in group A, versus 43.75%, 18.7%, and 12.5% in group B at one-, three, and six-month follow-up visits respectively. There was statistically significant at one month only regarding V5 patency rate No significant difference was noted between the two groups regarding V8 patency rates. Patent V8 was detected in 85.7% and 66.7% of patients in Groups A and B respectively. This rate was 85.7%, 71.4%, and 42.9% in group A, 50%, 33.3%, and 14.3% in group B at one-, three-, and six-month follow-up visits respectively. There is no significant difference in the marker of graft recovery (INR, AST, ALT and TB) at different time points, but it showed a significant decline in each group when compared to the initial value. Small for size syndrome was detected in 9.1% and 16.7% of recipients in Groups A and B respectively, with no significant difference between them. Three patients died in our study (10%). One patient died of hepatic artery thrombosis, while two died from multiorgan failure. Based on the results of our study, it could be included that: Both reconstruction techniques were associated with comparable patency outcomes. However, end-to-side configuration is associated with better patency and less incidence of SFSS. This concept should not be generalized in the transplantation practice till performing more studies with larger patient sample.