title: Drainage patterns of right and accessory hepatic veins: anatomical-functional classification derived from 3-dimensional CT reconstructions.
abstract: OBJECTIVE
  Inadequate knowledge of the right (RHV) and accessory (IHV) hepatic 'venous drainage' territories can lead to severe postoperative venous congestion after right graft live donor liver transplantation. The purpose of our study was to define the anatomical-functional RHV and IHV drainage territories.
  
  
  METHODS
  One hundred and forty consecutive live liver donor candidates were evaluated by means of 3-D CT reconstructions and 3-D virtual hepatectomies. Three RHV/IHV drainage patterns were identified and 'risky' configurations for right graft resections were defined.
  
  
  RESULTS
  Livers with 'small' IHV drainage volumes (90.1±63.2mL) had dominant type IRHV/ IHV or non-dominant type III-RHV/IHV total liver (TL) complexes. All other cases had 'large' IHV volumes (294.7±115.5mL, p<0.001) with dominant type II-RHV/IHV TL complexes. Loss of IHV drainage volume (such as with no IHV reconstruction) in these cases was associated with a 'dominance transition' from right (RHV) to middle (MHV) hepatic veins, placing the grafts at 'high risk' for venous congestion.
  
  
  CONCLUSIONS
  Type II-RHV/IHV complexes with large IHV drainage volumes are at 'high risk' for venous congestion in live donor liver transplantation.
authors.affiliation: Department of General, Thoracic and Transplantation Surgery, University Hospital, Kiel, Germany.
authors.forename: Shahin
authors.initials: S
authors.lastname: Minouchehr
authors.forename: Arnold
authors.initials: A
authors.lastname: Radtke
authors.forename: Georgios C
authors.initials: GC
authors.lastname: Sotiropoulos
authors.forename: Ernesto P
authors.initials: EP
authors.lastname: Molmenti
authors.forename: Felix
authors.initials: F
authors.lastname: Braun
authors.forename: Milo
authors.initials: M
authors.lastname: Hindennach
authors.forename: Human
authors.initials: H
authors.lastname: Honarpisheh
authors.forename: Vito R
authors.initials: VR
authors.lastname: Cicinnati
authors.forename: Massimo
authors.initials: M
authors.lastname: Malagó
authors.forename: Dieter C
authors.initials: DC
authors.lastname: Broering
authors.forename: Tobias
authors.initials: T
authors.lastname: Schroeder
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008102:Liver Circulation; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*