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Unusual presentation of left hepatic vein in deceased donor: case report
S Gruttadauria1, D Pagano, D Cintorino
1Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), University of Pittsburgh Medical Center, Palermo, Italy. sgruttadauria@ismett.edu
Insights
A rare left hepatic vein anomaly in a deceased liver donor required surgical modification. Ex situ reduction of liver segments is a viable option when graft viability is uncertain.
Area of Science:
- Hepatobiliary surgery
- Transplant surgery
- Vascular anomalies
Background:
- Liver transplantation relies on adequate vascular and biliary reconstruction.
- Hepatic vein anomalies can complicate standard surgical procedures.
- Deceased donor assessment is critical for successful organ procurement.
Observation:
- A deceased donor presented with an anomalous left hepatic vein.
- This vein joined the right and middle hepatic veins via a common trunk before draining into the right atrium.
- A thin tissue bridge connected the left hepatic vein to the suprahepatic inferior vena cava cuff.
Findings:
- The anomalous left hepatic vein was surgically separated from the common trunk.
- Ex situ reduction of the left lateral liver segments was performed using a harmonic scalpel.
- This allowed for the successful preparation of the liver graft despite the anomaly.
Implications:
- Surgical management of hepatic vein anomalies is feasible.
- Ex situ reduction offers a solution for utilizing grafts with uncertain segment viability.
- This technique can expand the donor pool for liver transplantation.
Abstract:
An anomaly of the left hepatic vein was discovered in a deceased donor for whole liver transplantation. This vein was attached by a thin bridge of tissue to the suprahepatic inferior vena cava cuff, which received the right and middle hepatic vein in a common trunk. The left hepatic vein and the common trunk drained together into the right atrium. The thin bridge of tissue connecting the 2 independent vessels was severed, and ex situ reduction of the left lateral segments was using a harmonic scalpel. Although a graft with reduced size is not ideal, ex situ reduction should be considered a valuable option when viability of the left lateral segments is uncertain in the donor or at the back table.
