title: Territorial belonging of the middle hepatic vein in living liver donor candidates evaluated by three-dimensional computed tomographic reconstruction and virtual liver resection.
abstract: BACKGROUND
  Postoperative venous congestion can lead to graft and remnant liver failure in living donor liver transplantation. This study was designed to delineate 'territorial belonging' of the middle hepatic vein (MHV) and to identify hepatic venous anatomy at high risk of outflow congestion.
  
  
  METHODS
  MHV belonging patterns for right (RHL) and left (LHL) hemilivers were evaluated by three-dimensional computed tomographic reconstruction and virtual hepatectomy in 138 consecutive living liver donor candidates.
  
  
  RESULTS
  The right hepatic vein (RHV) was dominant in 84.1 per cent and an accessory inferior hepatic vein (IHV) was present in 47.1 per cent of livers. Three MHV belonging types were identified for the RHL. Strong and complex MHV types A and C were associated with large RHL venous congestion. The MHV belonged to the LHL in 65.9 per cent, draining 37 per cent of this hemiliver. In virtual liver resections, left MHV type D was a risk category for small left liver remnants.
  
  
  CONCLUSIONS
  MHV territorial belonging types A and C were identified as high risk for RHL venous congestion. Their presence should prompt consideration of either inclusion of the MHV with the right graft or reconstruction of its tributaries, and preservation of IHV territory.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Radtke
authors.forename: G
authors.initials: G
authors.lastname: Sgourakis
authors.forename: G C
authors.initials: GC
authors.lastname: Sotiropoulos
authors.forename: E P
authors.initials: EP
authors.lastname: Molmenti
authors.forename: F H
authors.initials: FH
authors.lastname: Saner
authors.forename: S
authors.initials: S
authors.lastname: Timm
authors.forename: M
authors.initials: M
authors.lastname: Malagó
authors.forename: H
authors.initials: H
authors.lastname: Lang
mesh_terms: D000328:Adult; D000465:Algorithms; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging; D006498:Hepatectomy / Q000379:methods; D006503:Hepatic Veins / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D006801:Humans; D021621:Imaging, Three-Dimensional; D008099:Liver / Q000098:blood supply* / Q000000981:diagnostic imaging; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D009929:Organ Size; D011300:Preoperative Care; D015641:Radiography, Interventional; D014057:Tomography, X-Ray Computed / Q000379:methods*