Introduction: The difficulty and challenge of harvesting a right lobe graft without MHV drainage is reconstructing the outflow tract of the hepatic veins. Unlike the whole graft transplant operation, venous reconstruction in right lobe LDLT is perhaps more tricky and a perfect anastomosis is more difficult to construct. With the inclusion or the reconstruction of the MHV, early graft function is satisfactory. The inclusion of the MHV or not in the donor’s right lobectomy should be based on sound criteria to provide adequate functional liver mass for the recipient, while keeping the risk to the donor to a minimum.

Objective: To investigate the safety of different modalities of venous outflow reconstruction in right lobe LDLT grafts without MHV (including MHV tributaries; Segments V, VIII, and accessory veins) and establishing criteria for such reconstructions. Besides, comparing patients with single hepatic vein anastmosis, and patients who required complex venous reconstruction regarding operative details and outcomes.

Materials and Methods: This is both a prospective and retrospective study conducted in two centers: National Liver Institute: 40 cases of Living Donor Liver Transplant; Menoufiya University-Egypt from January 2009 to January 2011. The results were finalized, analyzed in Royal Free Hospital under Professor Brian Davidson’s supervision: Liver transplant Department, Royal Free Hospital, University College London (UCL), London, UK, under UK/Egyptian Joint PhD Supervision Scheme. 40 cases underwent Rt. lobe LDLT without MHV; Group A (Venous Outflow Reconstruction patients with more than one HV anast.) (n=16), Group B (Patients with single HV anast.) (n=24) Both groups were compared regarding; indications for reconstruction, complications, and operative details. Besides, describing different modalities used for venous outflow reconstruction.

Results: No deaths occurred in any of the donors. 40 cases underwent LDLT without MHV (with the exception of two cases). 24 cases had single RHV anastmosis, 16 cases had more than one single hepatic vein, 14 cases out of them had two vein anastmosis. Out of these 16 cases, there were 6 cases who had different modalities of vein grafts and venoplasty, and they are doing well till now. There was a significant increase in operative details (cold ischemia, warm ischemia time, and hepatic venous anastmosis time) in Group A than in Group B; with means of 68.75, 57.875, 34.68 versus 51.25, 43.33, and 17.70 respectively. When the comparison came to the complications and outcomes in terms of laboratory findings (total Bilirubin on three days levels and one month levels), overall hospital stay, three months survival and one year survival there were not significant differences between both groups.

Conclusions: In summary, HV reconstruction in right-lobe LDLT is technically challenging. A custom-made strategy in individuals may be necessary depending on whether significant MHV tributaries and major SHVs are present. In our institute, we believe that Adult