title: Risk of venous congestion in live donors of extended right liver graft.
abstract: OBJECTIVE
  To investigate middle hepatic vein (MHV) management in adult living donor liver transplantation and safer remnant volumes (RV).
  
  
  METHODS
  There were 59 grafts with and 12 grafts without MHV (including 4 with MHV-5/8 reconstructions). All donors underwent our five-step protocol evaluation containing a preoperative protocol liver biopsy Congestive vs non-congestive RV, remnant-volume-body-weight ratios (RVBWR) and postoperative outcomes were evaluated in 71 right graft living donors. Dominant vs non-dominant MHV anatomy in total liver volume (d-MHV/TLV vs nd-MHV/TLV) was constellated with large/small congestion volumes (CV-index). Small for size (SFS) and non-SFS remnant considerations were based on standard cut-off- RVBWR and RV/TLV. Non-congestive RVBWR was based on non-congestive RV.
  
  
  RESULTS
  MHV and non-MHV remnants showed no significant differences in RV, RV/TLV, RVBWR, total bilirubin, or INR. SFS-remnants with RV/TLV < 30% and non-SFS-remnants with RV/TLV ≥ 30% showed no significant differences either. RV and RVBWR for non-MHV (n = 59) and MHV-containing (n = 12) remnants were 550 ± 95 mL and 0.79 ± 0.1 mL vs 568 ± 97 mL and 0.79 ± 0.13, respectively (P = 0.423 and P = 0.919. Mean left RV/TLV was 35.8% ± 3.9%. Non-MHV (n = 59) and MHV-containing (n = 12) remnants (34.1% ± 3% vs 36% ± 4% respectively, P = 0.148. Eight SFS-remnants with RVBWR < 0.65 had a significantly smaller RV/TLV than 63 non-SFS-remnants with RVBWR ≥ 0.65 [SFS: RV/TLV 32.4% (range: 28%-35.7%) vs non-SFS: RV/TLV 36.2% (range: 26.1%-45.5%), P < 0.009. Six SFS-remnants with RV/TLV < 30% had significantly smaller RVBWR than 65 non-SFS-remnants with RV/TLV ≥ 30% (0.65 (range: 0.6-0.7) vs 0.8 (range: 0.6-1.27), P < 0.01. Two (2.8%) donors developed reversible liver failure. RVBWR and RV/TLV were concordant in 25%-33% of SFS and in 92%-94% of non-SFS remnants. MHV management options including complete MHV vs MHV-4A selective retention were necessary in n = 12 vs n = 2 remnants based on particularly risky congestive and non-congestive volume constellations.
  
  
  CONCLUSIONS
  MHV procurement should consider individual remnant congestive- and non-congestive volume components and anatomy characteristics, RVBWR-RV/TLV constellation enables the identification of marginally small remnants.
authors.affiliation: Arnold Radtke, Department of General and Transplantation Surgery, University Hospital Tuebingen, D-72076 Tuebingen, Germany.
authors.forename: Arnold
authors.initials: A
authors.lastname: Radtke
authors.affiliation: Arnold Radtke, Department of General and Transplantation Surgery, University Hospital Tuebingen, D-72076 Tuebingen, Germany.
authors.forename: George
authors.initials: G
authors.lastname: Sgourakis
authors.affiliation: Arnold Radtke, Department of General and Transplantation Surgery, University Hospital Tuebingen, D-72076 Tuebingen, Germany.
authors.forename: Ernesto P
authors.initials: EP
authors.lastname: Molmenti
authors.affiliation: Arnold Radtke, Department of General and Transplantation Surgery, University Hospital Tuebingen, D-72076 Tuebingen, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Beckebaum
authors.affiliation: Arnold Radtke, Department of General and Transplantation Surgery, University Hospital Tuebingen, D-72076 Tuebingen, Germany.
authors.forename: Vito R
authors.initials: VR
authors.lastname: Cicinnati
authors.affiliation: Arnold Radtke, Department of General and Transplantation Surgery, University Hospital Tuebingen, D-72076 Tuebingen, Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Schmidt
authors.affiliation: Arnold Radtke, Department of General and Transplantation Surgery, University Hospital Tuebingen, D-72076 Tuebingen, Germany.
authors.forename: Heinz-Otto
authors.initials: HO
authors.lastname: Peitgen
authors.affiliation: Arnold Radtke, Department of General and Transplantation Surgery, University Hospital Tuebingen, D-72076 Tuebingen, Germany.
authors.forename: Christoph E
authors.initials: CE
authors.lastname: Broelsch
authors.affiliation: Arnold Radtke, Department of General and Transplantation Surgery, University Hospital Tuebingen, D-72076 Tuebingen, Germany.
authors.forename: Massimo
authors.initials: M
authors.lastname: Malagó
authors.affiliation: Arnold Radtke, Department of General and Transplantation Surgery, University Hospital Tuebingen, D-72076 Tuebingen, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Schroeder
mesh_terms: D000328:Adult; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006503:Hepatic Veins / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006940:Hyperemia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008099:Liver / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery*; D008102:Liver Circulation; D017093:Liver Failure / Q000175:diagnosis / Q000209:etiology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009929:Organ Size; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Liver volume; Living donor liver transplantation; Remnant volume; Small-for-size; Small-for-size syndrome