Objective: Establishing optimal hepatic venous outflow is the key for a successful outcome of living donor liver transplantation using a right lobe graft. The purpose of this article is to illustrate the surgical techniques of middle hepatic vein reconstruction with an interposition vein graft in living donor liver transplant recipients using a modified right lobe graft, normal postoperative Doppler sonographic findings, and various Doppler sonographic abnormalities suggestive of hepatic venous congestion.
Conclusion: Hepatic venous congestion after living donor liver transplantation using a right lobe graft may produce various abnormalities on Doppler sonography. In addition to allowing the patency of the middle hepatic vein tributaries and interposition vein graft to be assessed during the early postoperative period, Doppler sonography can depict the flow direction in the portal vein and in the middle hepatic vein tributaries; therefore, Doppler sonography can reveal reversal of portal flow direction in patients with acute and severe venous congestion and can show the presence of a functional intrahepatic anastomosis between the hepatic vein tributaries during the follow-up period in those with improved congestion.