Branching patterns and drainage territories of the middle hepatic vein in computer-simulated right living-donor hepatectomies.

Full Abstract

Full right hepatic grafts are most frequently used for adult-to-adult living donor liver transplantation (LDLT). One of the major problems is venous drainage of segments 5 and 8. Thus, this study was designed to provide information on venous drainage of right liver lobes for operation-planning. Fifty-six CT data sets from routine clinical imaging were evaluated retrospectively using a liver operation-planning system. We defined and analyzed venous drainage segments and the impact of anatomic variations of the middle hepatic vein (MHV) on venous outflow from segments 5 and 8. MHV variations led to significant shifts of segment 5 drainage between the middle and right hepatic vein. In cases with the most frequent MHV branching pattern (n = 33), a virtual hepatectomy closely right to the MHV intersected drainage vessels that provided drainage for 30% of the potential graft, not taking into account potential veno-venous shunts. In individuals with inferior MHV branches that extend far into segments 5 and 6 (n = 10), the overall graft volume at risk of impaired venous drainage increased by 5% (p < 0.001). If this is confirmed in clinical trials and correlated with intraoperative findings, the use of liver operation-planning systems would be beneficial to improve overall outcome after right lobe LDLT.

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Author information

Author/s: Neumann, J O (JO); Thorn, M (M); Fischer, L (L); Schöbinger, M (M); Heimann, T (T); Radeleff, B (B); Schmidt, J (J); Meinzer, H P (HP); Büchler, M W (MW); Schemmer, P (P);

Affiliation: Department of General Surgery, Ruprecht-Karls-University, Heidelberg, Germany.

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons (Am J Transplant), published in Denmark. (Language: eng)

Reference: 2006-Jun; vol 6 (issue 6) : pp 1407-15

Dates: Created 2006/05/11; Completed 2006/10/25; Revised 2007/02/14;

PMID: 16686764, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Computer Simulation
Drainage
Functional Laterality
Hepatectomy - methods
Hepatic Veins - anatomy & histology; surgery

Humans
Liver - anatomy & histology
Liver Circulation
Living Donors
Tissue and Organ Procurement - methods

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