Background:Differing views persist on the need for V5&8 venous outflow reconstruction in right lobe living donor liver transplantationt(LDLT). Many centers in Asia and Europe believe in preserving Middle hepatic vein (MHV) trunk and using a conduit to IVC / reconstruct segments 5 & 8 vein using cryopreserved /PTFE grafts. We follow policy of partial /subtotal MHV retrieval with graft that is extended with a conduit of autologous portal vein from the explant liver.Aims:Analyse long term patency of MHV outflow in Right lobe grafts using autologous portal vein segment.Methods: Between March 2013 to November 2014, we did 62 LDLT. 28 were done before Nov 2014((24 extended Right lobe, 1 Right lobe, 3 left lobe /left lateral graft). In 24, MHV was extended on back table using portal vein segment harvested from the explanted liver.Technique. During recipient hepatectomy 2 clamps are placed on the portal vein first at the upper border of duodenum and the proximal clamp just beyond the confluence of right and left portal vein. After division the stump towards the liver is closed with 5'0 prolene. Portal vein with confluence is dissected on the back table and up to 2inch segment can be retrieved. MHV reconstruction involves anastomosing a segment of portal vein (2-3 cm) to the end of MHV, common MHV +V8 opening or a Y graft to MHV + V8 The other end is anastomosed to a new venotomy on the IVC during implantation. Results: Four (4/24) recipients died in the first month. Of the remaining 20, follow-up USG / CT > 12 months were available for 14 patients. One patient had a normal USG at 9 mths, 2 died at 6 and 9 mths due to sepsis and 3 patients are following at a separate center. All 15 Patients with available records had patent MHV (100%) demonstrated (14 USG, 1 CT) beyond 9 months and all 14 (100%)had MHV patent after 12 mths.Conclusion: Autologous portal vein segment retrieved from the explant liver provides excellent long term patency for MHV extension in extended right lobe graft. It avoids groin incision(saphenous graft), immunological or cryopreservation damage with non autologous / cryopreserved vessel and higher thrombosis rates reported with recanalised umbilical vein and PTFE grafts.

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