Donor/recipient algorithm for management of the middle hepatic vein in right graft live donor liver transplantation

Radtke, A.; Sgourakis, G.; Sotiropoulos, G.C.; Beckebaum, S.; Molmenti, E.P.; Saner, F.H.; Schroeder, T.; Nadalin, S.; Schenk, A.; Lang, H.; Malagó, M.; Broelsch, C.E.

doi:10.1016/j.amjsurg.2009.03.024

« Previous Next »The American Journal of Surgery
Volume 199, Issue 5 , Pages 708-715, May 2010

Donor/recipient algorithm for management of the middle hepatic vein in right graft live donor liver transplantation

A. Radtke, M.D.
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
- Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Mainz, Germany
- Corresponding author: Tel.: 49-6131-172893; fax: 49-6131-176630
G. Sgourakis, M.D.
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
- Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Mainz, Germany
G.C. Sotiropoulos, M.D., B.A.
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
- Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Mainz, Germany
S. Beckebaum, M.D.
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
E.P. Molmenti, M.D., M.B.Ch.B.
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
F.H. Saner, M.D.
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
T. Schroeder, M.D.
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
S. Nadalin, M.D.
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
A. Schenk, Ph.D.
- MeVis Center for Medical Diagnostic Systems and Visualization, University of Bremen, Bremen, Germany
H. Lang, M.D., F.A.C.S.
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
- Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Mainz, Germany
M. Malagó, M.D.
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
C.E. Broelsch, M.D., F.A.C.S.
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany

Received 1 February 2009; received in revised form 6 March 2009 published online 15 January 2010.

Abstract

Background

The aim of this study was to delineate an algorithm for donor and recipient criteria and middle hepatic vein (MHV) management in right-graft live-donor liver transplantation (LDLT) on the basis of computerized 3-dimensional computed tomographic image analysis.

Methods

Data on 94 consecutive right-graft LDLTs were prospectively collected. Graft and remnant data for the first 23 cases were retrospectively evaluated by means of 3-dimensional computed tomographic reconstructions, and on the basis of that preliminary series, a graft selection algorithm using 3 parameters—hepatic vein dominance classification, graft and remnant graft volume/body weight ratios, and congestion volumes—was created. It was subsequently applied to the next 71 right-graft LDLTs.

Results

Fifty-nine right grafts contained the MHV. Four of the 12 grafts with no MHVs required MHV reconstructions. In 18 cases, small liver grafts were used. The postoperative function of liver grafts and remnants with versus without MHVs was not statistically different.

Conclusions

The proposed algorithm favored the inclusion of the MHV with the right grafts. It also allowed for the procurement of grafts that were potentially small for size without compromising donor or recipient safety.

Keywords: Liver surgery, Liver anatomy, 3D CT imaging, Adult LDLT, Hepatic vein classification