ArticleLangenbeck's archives of surgery2026
Triangular anastomosis enhances early patency of small middle hepatic vein tributaries in right lobe living donor liver transplantation.
Article in Langenbeck's archives of surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn 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.
methodsA 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.
resultsBaseline 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).
conclusionsWithin 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.
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