[Specific considerations in living-donor liver transplantation]

Area of Science:

• Hepatobiliary surgery
• Transplant surgery
• Surgical anatomy

Context:

• Adult living liver donor transplantation (LLDT) is a vital alternative to deceased donor liver transplantation.
• Donor safety and graft quality are paramount in LLDT.
• The middle hepatic vein (MHV) presents anatomical challenges during right lobe liver transplantation.

Purpose:

• To investigate the anatomical requirements for MHV reconstruction in LLDT.
• To accurately describe the discrepancy between portal vein inflow and hepatic vein outflow.
• To assess the clinical significance of porto-hepatic disparity in graft selection.

Summary:

• Analysis of 130 LLDT donors using MeVis software revealed significant variations in hepatic vein dominance and porto-hepatic inflow/outflow.
• The right hepatic vein was dominant in 64.6% of cases.
• A porto-hepatic disparity index (shift) averaged 28.2%, highlighting discrepancies between portal territories and venous drainage, particularly around the MHV (R²=0.5463).

Impact:

• Findings emphasize the importance of considering portal-hepatic outflow discrepancies when determining the necessity of MHV reconstruction.
• This research aids in optimizing surgical planning for right lobe liver transplantation.
• Improved understanding can lead to safer donor hepatectomies and better graft outcomes.