title: Segment 4 and the left lateral segment regeneration pattern after resection of the middle hepatic vein in a living donor right hepatectomy.
abstract: BACKGROUND
  Inclusion of the middle hepatic vein (MHV) with a right hepatectomy (RH) in live donor liver transplantation improves venous drainage of the anterior sector of the graft. Its long-term effects on donor left liver (LL) regeneration are not well described.
  
  
  METHODS
  Donors who underwent RH with MHV (MHV+, n = 12) were compared with donors who underwent RH with preservation of the MHV (MHV-, n = 24). Peri-operative complications and volume of the entire liver and individual segments were evaluated at 1 year post-donation.
  
  
  RESULTS
  There was a trend towards a higher complication rate in the MHV+ group (41% versus 25%), without reaching statistical significance (P = 0.3). Males, high body mass index (BMI) and a smaller residual liver volume (RLV) were predictors for greater LL regeneration. MHV+ donors had impaired regeneration of segment 4 (S4) at 1 year, and compensatory greater left lateral segment regeneration. The absence of venous drainage of S4 (V4) to left hepatic vein (LHV) was a predictor of impaired S4 regeneration.
  
  
  CONCLUSIONS
  Regeneration of S4 is impaired in MHV+ donors. Caution should be taken when considering MHV removal on donors with dominant S4, especially on those with potential increased demand for liver regeneration, such as males, higher BMI and a smaller RLV.
authors.affiliation: Recanati-Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Nir
authors.initials: N
authors.lastname: Lubezky
authors.forename: Irina
authors.initials: I
authors.lastname: Oyfe
authors.forename: Alan G
authors.initials: AG
authors.lastname: Contreras
authors.forename: Juan P
authors.initials: JP
authors.lastname: Rocca
authors.forename: Dianne LaPointe
authors.initials: DL
authors.lastname: Rudow
authors.forename: Tara
authors.initials: T
authors.lastname: Keegan
authors.forename: Bashir
authors.initials: B
authors.lastname: Taouli
authors.forename: Leona
authors.initials: L
authors.lastname: Kim-Schluger
authors.forename: Sander
authors.initials: S
authors.lastname: Florman
authors.forename: Thomas
authors.initials: T
authors.lastname: Schiano
authors.forename: Marcelo
authors.initials: M
authors.lastname: Facciuto
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008102:Liver Circulation; D008115:Liver Regeneration; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008279:Magnetic Resonance Imaging; D008297:Male; D009929:Organ Size; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome