Donor/recipient algorithm for management of the middle hepatic vein in right graft live donor liver transplantation.
BACKGROUND
The aim of this study was to delineate an algorithm for donor and recipient criteria and middle hepatic vein (MHV) management in right-graft live-donor liver transplantation (LDLT) on the basis of computerized 3-dimensional computed tomographic image analysis.


METHODS
Data on 94 consecutive right-graft LDLTs were prospectively collected. Graft and remnant data for the first 23 cases were retrospectively evaluated by means of 3-dimensional computed tomographic reconstructions, and on the basis of that preliminary series, a graft selection algorithm using 3 parameters-hepatic vein dominance classification, graft and remnant graft volume/body weight ratios, and congestion volumes-was created. It was subsequently applied to the next 71 right-graft LDLTs.


RESULTS
Fifty-nine right grafts contained the MHV. Four of the 12 grafts with no MHVs required MHV reconstructions. In 18 cases, small liver grafts were used. The postoperative function of liver grafts and remnants with versus without MHVs was not statistically different.


CONCLUSIONS
The proposed algorithm favored the inclusion of the MHV with the right grafts. It also allowed for the procurement of grafts that were potentially small for size without compromising donor or recipient safety.
Radtke
A
A
Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany. radtke@ach.klinik.uni-mainz.de
Sgourakis
G
G
Sotiropoulos
G C
GC
Beckebaum
S
S
Molmenti
E P
EP
Saner
F H
FH
Schroeder
T
T
Nadalin
S
S
Schenk
A
A
Lang
H
H
Malagó
M
M
Broelsch
C E
CE
D000465:Algorithms; D000704:Analysis of Variance; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods; D006503:Hepatic Veins / Q000601:surgery / Q000637:transplantation*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008099:Liver / Q000033:anatomy & histology / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D008102:Liver Circulation; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment; D009927:Tissue and Organ Procurement; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome