title: Vena cava encirclement predicts difficult native hepatectomy.
abstract: Recipient hepatectomy is a challenging liver transplantation (LT) procedure that has life-threatening complications. The current predictive mortality clinic-biological scores (Child/Model for End-Stage Liver Disease [MELD]) do not take into consideration the recipient's liver anatomy. The aim of this study was to evaluate the impact of the dorsal sector anatomy of a cirrhotic liver on the morbidity/mortality rates of hepatectomy. A multicenter retrospective study (clinic-biological and morphologic) was performed from 2013 to 2014. The degree of encirclement of the inferior vena cava (IVC) by the dorsal sector of the liver was measured. The study population included 320 patients. Seventy-four (23%) patients had complete IVC encirclement. A correlation (P = 0.01) has been reported between the existence of a circular dorsal sector and the number of transfusions during LT (4 packed red blood cell [PRBC] transfusions in the group without IVC versus 7 PRBC transfusions in the other group). The existence of such anatomy increases the relative risk of early reoperation for IVC bleeding by 31% (P = 0.05). There is a correlation between alcoholic cirrhosis and dorsal-sector hypertrophy (126 cc versus 147.5 cc; P = 0.05). Concerning surgical time, we found no significant between-group differences. Compared to the severity of cirrhosis, an inverse correlation was observed between the MELD and Child scores and the dorsal sector hypertrophy (P < 0.001). No significant difference in terms of transfusion was found between the temporary portocaval shunt group (n = 168) and the other group (n = 152). The presence of a circular sector is associated with an increased risk of hemorrhage during hepatectomy, as well as an immediate postoperative risk of reoperation. Liver Transplantation 22 906-913 2016 AASLD.
authors.affiliation: Departments of General Surgery, Division of Transplantation, College of Medicine, University of Montpellier, Montpellier, France.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Panaro
authors.affiliation: Departments of General Surgery, Division of Transplantation, College of Medicine, University of Montpellier, Montpellier, France.
authors.forename: Gildas
authors.initials: G
authors.lastname: Boisset
authors.affiliation: Departments of Anesthesiology and Critical Care Medicine, University of Montpellier, Montpellier, France.
authors.forename: Gérald
authors.initials: G
authors.lastname: Chanques
authors.affiliation: Departments of Radiology, Faculty of Medicine, Saint Eloi Hospital, University of Montpellier, Montpellier, France.
authors.forename: Boris
authors.initials: B
authors.lastname: Guiu
authors.affiliation: Departments of General Surgery, Division of Transplantation, College of Medicine, University of Montpellier, Montpellier, France.
authors.forename: Astrid
authors.initials: A
authors.lastname: Herrero
authors.affiliation: Departments of General Surgery, Division of Transplantation, College of Medicine, University of Montpellier, Montpellier, France.
authors.forename: Hassan
authors.initials: H
authors.lastname: Bouyabrine
authors.affiliation: Departments of General Surgery, Division of Transplantation, College of Medicine, University of Montpellier, Montpellier, France.
authors.forename: Georges Philippe
authors.initials: GP
authors.lastname: Pageaux
authors.affiliation: Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier, Rennes, France.|INSERM, UMR991, Foie, Métabolisme et Cancer, Université de Rennes 1, Rennes, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Boudjema
authors.affiliation: Departments of General Surgery, Division of Transplantation, College of Medicine, University of Montpellier, Montpellier, France.
authors.forename: Francis
authors.initials: F
authors.lastname: Navarro
mesh_terms: D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D058625:End Stage Liver Disease / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D006984:Hypertrophy / Q000150:complications; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011167:Portacaval Shunt, Surgical; D011169:Portal Vein / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D014682:Vena Cava, Inferior / Q000473:pathology* / Q000601:surgery