A 44-year-old man with hepatitis C virus-related cirrhosis underwent LDLT. The donor was his identical twin elder brother. On computed tomography, the markedly dilated umbilical vein was observed as a hepatofugal collateral. An extended left liver graft with the caudate lobe was harvested in a conventional manner. One orifice outflow reconstruction was performed by using an umbilical vein which was extracted from the recipient. This vein-flap sheet was sutured to the outflow orifice of the liver graft in a two-thirds circle on the ventral side. One wide outflow orifice with a 90-mm vein umbilical-vein flap on the ventral wall of outflow was created. Excellent triphasic waveforms and velocities were demonstrated on postoperative Doppler ultrasonography. The post-transplant course was uneventful, with no need for immunosuppressants, and the patient was discharged without any complications on postoperative day 27. The volume of left liver increased from 406 cm3 to 1,372 cm3 during the first 6 weeks after transplantation.

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