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Donor/recipient algorithm for management of the middle hepatic vein in right graft live donor liver transplantation
A Radtke1, G Sgourakis, G C Sotiropoulos
1Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany. radtke@ach.klinik.uni-mainz.de
Insights
A new algorithm for right-graft live-donor liver transplantation (LDLT) prioritizes middle hepatic vein (MHV) inclusion. This approach safely enables the use of smaller liver grafts, improving donor and recipient outcomes.
Area of Science:
- Hepatobiliary Surgery
- Transplantation Surgery
- Medical Imaging
Background:
- Live-donor liver transplantation (LDLT) involves complex graft selection.
- Right-graft LDLT requires careful management of hepatic veins.
- Standardized criteria for graft selection are crucial for successful outcomes.
Purpose of the Study:
- To develop an algorithm for donor and recipient criteria in right-graft LDLT.
- To define middle hepatic vein (MHV) management strategies based on 3D CT analysis.
- To optimize graft selection and improve safety in right-graft LDLT.
Main Methods:
- Prospective data collection from 94 right-graft LDLTs.
- Retrospective analysis of 23 cases using 3D CT reconstructions.
- Development and application of a graft selection algorithm based on hepatic vein dominance, volume ratios, and congestion.
Main Results:
- Fifty-nine of 94 right grafts included the MHV.
- Four of 12 grafts without MHVs required reconstruction.
- Postoperative liver graft function was similar regardless of MHV presence.
- Small liver grafts were utilized in 18 cases.
Conclusions:
- The developed algorithm favors including the MHV with right grafts.
- This approach facilitates the use of potentially small grafts without compromising safety.
- The algorithm enhances donor and recipient safety in right-graft LDLT.
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.
