LAUSR

A 45-year-old male patient with liver cirrhosis due to nonalcoholic steatohepatitis applied to our center for liver transplantation. He was registered on the waiting list for deceased donor liver transplantation. However, 2 years later, his condition gradually deteriorated due to ascites and edema, and he and his family wished for LDLT instead of waiting for a deceased donor. His body weight, height, and body mass index were 173 cm, 87 kg, and 29.0 kg/m, respectively. He had massive ascites but no episodes of encephalopathy. His total bilirubin (T-Bil) level, albumin level, and prothrombin time (PT; %) were 2.6mg/dL, 3.0 g/dL, and 45%, respectively, resulting in a Child-Pugh score of 10 (grade C) and a Model for End-Stage Liver Disease score of 15. His 44-year-old wife was evaluated as a donor. Her computed tomography (CT) scan demonstrated that the RAPV branched off from the UP (Fig. 1A,B) and the right anterior hepatic artery (RAHA) also arose from the left hepatic artery (Fig. 1C). Drip infusion CT cholangiography demonstrated that the common hepatic duct trifurcated into the left, anterior, and posterior ducts (Fig. 2A). CT volumetry showed that the left lobe graft or the posterior segment graft did not fulfill our criteria for the minimum graft volume (0.6% of the recipient body weight; Table 1). The right lobe graft was abandoned because of the technical difficulties in reconstruction of PVs as well as the arteries. A left trisegmental graft was selected because CT volumetry showed sufficient volumes for both the graft and the remnant (Table 1). Simple reconstructions with a single orifice were expected for the PV and the hepatic artery.