Anatomical and physiological comparison of liver volumes among three frequent types of parenchyma transection in live donor liver transplantation.
OBJECTIVE
Adequate venous outflow is a prerequisite for successful live donor liver transplantation. Several techniques of liver transection have been established in both transplant and non-transplant hepatic surgery. The purpose of our study was to define and compare anatomical and physiological characteristics of venous drainage in the three most common types of liver transection techniques (Malagó, Cantlie, Pringle) encountered in live donor liver transplantation


METHODS
Volumes of both graft and remnant livers as well as individual hepatic vein territories were calculated by means of virtual 3-dimensional reconstructions of computed tomography images obtained from 55 potential live liver donors using the software HepaVision (MeVis, Germany). Belonging to the middle hepatic vein (MHV) was assigned according to the largest territorial volume on either right or left hemilivers. Livers from all potential donors were subject to virtual splitting (n=55). Findings were subsequently confirmed intraoperatively in those who underwent donor resection (n=27).


RESULTS
There were no statistically significant differences in hemiliver-volumes among the three types of liver partition. There was a predominance of MHV belonging to the right hemiliver: Malagó n=45 (82%) vs. Cantlie n=44 (80%) vs. Pringle n=44 (80%). Dominant right MHV hemiterritory showed a mean volume of 284-296 mL, accounting for 59-61% of total MHV volume. There were no significant differences among the three types of liver partition evaluated.


CONCLUSIONS
Our results demonstrate the reliability of virtual 3-dimensional reconstructions based on standard anatomical landmarks for both surgical planning and graft volume calculations. We believe our technique will help prevent small-for-size grafting and liver insufficiency resulting from inaccurate volumetric calculations. Our findings also support the observation that improved venous outflow might be achieved by including the MHV with the right liver graft without disadvantaging the left liver remnant. It is our hope that all these findings will translate into enhanced donor and recipient safety.
Radtke
Arnold
A
Department of General Surgery and Transplantation, University Hospital Essen, Essen, Germany.
Schroeder
Tobias
T
Molmenti
Ernesto P
EP
Sotiropoulos
Georgios C
GC
Schenk
Andrea
A
Paul
Andreas
A
Frilling
Andrea
A
Lang
Hauke
H
Nadalin
Silvio
S
Peitgen
Heinz O
HO
Broelsch
Christoph E
CE
Malagó
Massimo
M
D000328:Adult; D005260:Female; D006503:Hepatic Veins / Q000033:anatomy & histology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008099:Liver / Q000033:anatomy & histology* / Q000098:blood supply / Q000601:surgery; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014584:User-Computer Interface