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Published on: May 7, 2015
Hepatic veins anatomy and piggy-back liver transplantation
Ying-Zi Ming1, Ying Niu, Ming-Jie Shao
1Research Center of Chinese Health Ministry on Transplantation Medicine Engineering and Technology, The Third Xiangya Hospital, Central South University, Changsha 410013, China. yqf_china@163.com
Insights
Classifying hepatic vein anatomy aids in selecting optimal piggy-back liver transplantation (PBLT) techniques, reducing complications like outflow obstruction and Budd-Chiari syndrome.
Area of Science:
- Hepatology
- Surgical Anatomy
- Transplantation Surgery
Background:
- Piggy-back caval anastomosis (PBLT) is common in liver transplantation but risks complications such as outflow obstruction and Budd-Chiari syndrome.
- Understanding hepatic vein (HV) anatomy is crucial for mitigating these risks.
Purpose of the Study:
- To clarify the anatomy and variations of hepatic veins (HVs) draining into the inferior vena cava (IVC).
- To classify PBLT surgical techniques based on HV anatomy to minimize complications.
Main Methods:
- Analyzed HV anatomy in 248 liver transplant recipients from January 2004 to August 2011.
- Recorded HV drainage patterns, including short HVs entering the IVC.
Main Results:
- Classified HV drainage into five types (I-V) based on variations in HV confluence.
- Type I, II, and III HVs were suitable for classical PBLT.
- Type IVa HVs required venoplasty, while Type IVb and V HVs necessitated modified PBLT.
Conclusions:
- Hepatic vein anatomy can be classified based on IVC drainage patterns.
- This classification guides the selection of the most appropriate PBLT surgical approach.
Background:
The piggy-back caval anastomosis technique is widely used in orthotopic liver transplantation although it carries an increased risk of complications, including outflow obstruction and Budd-Chiari syndrome. The aim of this study is to clarify the anatomy and variations of hepatic veins (HVs) draining into the inferior vena cava (IVC), and to classify the surgical techniques of piggy-back liver transplantation (PBLT) based on the anatomy of HVs which can reduce the occurrence of complications.
Methods:
PBLT was performed in 248 consecutive cases at our hospital from January 2004 to August 2011. The anatomy of recipients' HVs was determined when removing the native diseased livers. Both anatomy of HVs and short HVs draining into the IVC were recorded. These data were collected and analyzed.
Results:
We classified anatomic variations of HVs in the 248 livers into five types according to the way of drainage into the IVC: type I (trunk type of left and middle HVs), 142 (57.3%) patients; type II (trunk type of right and middle HVs), 54 (21.8%); type III (trunk type of left, middle and right HVs), 14 (5.6%); type IV (non-trunk type of left, middle and right HVs), of which, type IVa, 16 (6.5%), in the same horizontal plane; type IVb, 18 (7.3%), in different horizontal planes; and type V (segment type), 4 (1.6%). The patients whose HVs anatomy belonged to types I, II and III underwent classical piggy-back liver transplantation. Type IVa patients had classical PBLT via HV venoplasty prior to piggy-back anastomosis, while type IVb patients and type V patients could only have modified PBLT.
Conclusion:
This study demonstrates that HVs can be classified according to the anatomy of their drainage into the IVC and we can use this classification to choose the best operative approach to PBLT.
