Donor Inferior Mesenteric Vein as a Conduit for Segment IV Venous Reconstruction in Pediatric LDLT : A Case Report

BACKGROUND: Optimal venous outflow is critical in living donor liver transplantation. In pediatric recipients, segment IV venous drainage is often overlooked but becomes essential in older children when adequate functional liver volume is required. CASE: We report a 5-year-old child weighing 15 kg with progressive familial intrahepatic cholestasis, who underwent living donor left lobe transplantation. The donor (mother) had a prominent segment IV tributary draining into the middle hepatic vein. To preserve optimal graft function, the segment IV venous tributary was reconstructed using the donor inferior mesenteric vein (IMV) as an interposition conduit. Postoperative Doppler confirmed satisfactory flow in the reconstructed vein. The child recovered uneventfully with good graft function on follow-up. CONCLUSION: Donor IMV is a safe and versatile conduit for segment IV venous reconstruction in pediatric living donor liver transplantation, especially when segment IV drainage is essential for adequate functional graft volume.