Feasibility assessment for tailoring preservation of segment VIII hepatic vein during left liver graft procurement.
OBJECTIVE
Procurement of left lobe (LL) graft occasionally induces large-sized hepatic venous congestion (HVC) at the remnant right liver. Isolated preservation of segment VIII vein (V8) could reduce this HVC, but it has been applied to only a small number of living donor operations to date.


METHODS
We investigated the indication of tailoring V8 preservation through the anatomical analyses and computer simulation in a large-volume donor pool. After setting up its surgical technique in 3 donor cases, we analyzed the liver anatomy of 147 LL graft donors.


RESULTS
We regarded the first anatomical condition as direct convergence of a large V8 branch on middle hepatic vein root, by which 27 livers were selected. The second was absence of complex hepatic vein branching at the graft cutting line, and 4 livers were excluded. The third was relatively large-sized HVC more than 35% of right lobe volume, and 11 livers were additionally excluded. Finally, 12 (8.2%) of 147 were left after 3-step selection processes. V8 preservation was estimated to reduce the total amount of HVC by 40%.


CONCLUSIONS
We think that tailoring V8 preservation seems to be indicated for 8.2% of LL graft donor livers according to the 3 anatomical conditions.
Hwang
Shin
S
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea.
Lee
Sung-Gyu
SG
Ha
Tae-Yong
TY
Ahn
Chul-Soo
CS
Park
Kwang-Min
KM
Kim
Ki-Hun
KH
Moon
Deok-Bog
DB
Song
Gi-Won
GW
Kim
Dong-Sik
DS
Jung
Jae-Pil
JP
D000293:Adolescent; D000328:Adult; D003198:Computer Simulation; D005260:Female; D006503:Hepatic Veins / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008099:Liver / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D014021:Tissue Preservation / Q000379:methods*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D009927:Tissue and Organ Procurement; D014057:Tomography, X-Ray Computed