title: Anatomical and physiological classification of hepatic vein dominance applied to liver transplantation.
abstract: BACKGROUND
  Proper outflow reconstruction is essential in LDLT. Preoperative planning requires meticulous attention to hepatic vein dominance patterns. The purpose of our study was to provide a combined anatomical-physiological classification of hepatic vein dominance useful for surgical decision-making in both donors and recipients.
  
  
  METHODS
  We analyzed 3-dimensional CT-imaging reconstructions of 55 potential live liver donors evaluated at our Institution between January 2003 and May 2004.
  
  
  RESULTS
  Our data revealed that: 1) The middle hepatic vein (MHV) and left hepatic vein (LHV) show a relative lack of anatomical diversity, whereas the right hepatic vein (RHV) exhibits multiple variants, 2) 45% donors had inferior hepatic veins (IHV) with anatomically and physiologically relevant venous drainage territories, 3) The RHV is usually dominant when present as a single vein without anatomical IHV (type 1A), or when considered as a complex with IHV (type 1Bx) (80% vs. 88%), 4) Only 55% of dominant type 1Bx RHV/IHV-complex automatically included a dominant type 1By RHV by itself, 5) A single RHV out of anatomical complex with IHV (type 1By) was dominant in only 48% of our donor candidates, 6) The MHV types 2A and 2By are strongly dominant accounting for up to 57% of total liver volume (TLV).
  
  
  CONCLUSIONS
  We propose a new classification based on both anatomical and physiological hepatic venous configurations. Our model also provides a new nomenclature that can be universally applied to preoperative planning in LDLT.
authors.affiliation: Department of General Surgery and Transplantation, University Hospital Essen, Hufelandstr. 55, D-45122 Essen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Radtke
authors.forename: T
authors.initials: T
authors.lastname: Schroeder
authors.forename: G C
authors.initials: GC
authors.lastname: Sotiropoulos
authors.forename: E
authors.initials: E
authors.lastname: Molmenti
authors.forename: A
authors.initials: A
authors.lastname: Schenk
authors.forename: A
authors.initials: A
authors.lastname: Paul
authors.forename: S
authors.initials: S
authors.lastname: Nadalin
authors.forename: H
authors.initials: H
authors.lastname: Lang
authors.forename: F
authors.initials: F
authors.lastname: Saner
authors.forename: H O
authors.initials: HO
authors.lastname: Peitgen
authors.forename: C E
authors.initials: CE
authors.lastname: Broelsch
authors.forename: M
authors.initials: M
authors.lastname: Malagò
mesh_terms: D000293:Adolescent; D000328:Adult; D003657:Decision Making; D005260:Female; D006503:Hepatic Veins / Q000033:anatomy & histology* / Q000502:physiology / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008099:Liver / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery*; D008102:Liver Circulation; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed