The influence of accessory right inferior hepatic veins on the venous drainage in right graft living donor liver transplantation.
OBJECTIVE
Proper venous outflow reconstruction is essential for the success of living donor liver transplantation (LDLT). It has also a decisive impact on postoperative graft dysfunction. The accessory right inferior hepatic veins (IHVs) usually drain parts of the lateral sector of the right hemiliver graft (RHL). The purpose of our study was to: (1) evaluate the drainage patterns of the IHVs in right hemiliver grafts; (2) analyze the influence of IHVs on the dominance relationships between the right and middle hepatic veins in RHL's; (3) evaluate some potential correlation between drainage patterns of IHVs and the portal vein anatomy.


METHODS
We analyzed 3-dimensional CT-imaging reconstructions of 71 potential live liver donors evaluated at our Institution between January 2003 and October 2004.


RESULTS
(1) Thirty-six (51%) donors had inferior hepatic veins (IHV) with detectable venous drainage territories, (2) the RHV/IHV-complex was dominant in 97% of cases, and the RHV as a single veinwithout anatomical IHV was dominant in 94% of right hemiliver grafts, (3) 27 of 71 livers (38%) showed a central (n=11) or peripheral (n=16) PV anomaly, (4) IHV provided a mean 32% of venous drainage in the right lateral sector, and in some cases drained up to 25% of the right medial sector irrespective of the PV anatomy, (5) such cases required IHV reconstruction to prevent severe tissue congestion in the right hemiliver graft.


CONCLUSIONS
Accurate insight into the drainage patterns of the right and middle hepatic veins and precise knowledge of the functional volume drained by the IHV are essential when planning for the proper outflow reconstruction of right hemiliver grafts in LDLT.
Radtke
Arnold
A
Department of General Surgery and Transplantation, University Hospital Essen, Essen, Germany.
Sotiropoulos
Georgios C
GC
Molmenti
Ernesto P
EP
Nadalinl
Silvio
S
Schroeder
Tobias
T
Schenk
Andrea
A
Saner
Fuat
F
Valentin-Gamazo
C
C
Dahmen
Uta
U
Spasov
Lubomir
L
Broelsch
Christoph E
CE
Malagò
Massimo
M
D000293:Adolescent; D000328:Adult; D005260:Female; D006503:Hepatic Veins / Q000033:anatomy & histology / Q000502:physiology*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008099:Liver / Q000098:blood supply*; D008102:Liver Circulation; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000502:physiology; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures