Risk of venous congestion in live donors of extended right liver graft.

Abstract

AIM:

To investigate middle hepatic vein (MHV) management in adult living donor liver transplantation and safer remnant volumes (RV).

METHODS:

There were 59 grafts with and 12 grafts without MHV (including 4 with MHV-5/8 reconstructions). All donors underwent our five-step protocol evaluation containing a preoperative protocol liver biopsy Congestive vs non-congestive RV, remnant-volume-body-weight ratios (RVBWR) and postoperative outcomes were evaluated in 71 right graft living donors. Dominant vs non-dominant MHV anatomy in total liver volume (d-MHV/TLV vs nd-MHV/TLV) was constellated with large/small congestion volumes (CV-index). Small for size (SFS) and non-SFS remnant considerations were based on standard cut-off- RVBWR and RV/TLV. Non-congestive RVBWR was based on non-congestive RV.

RESULTS:

MHV and non-MHV remnants showed no significant differences in RV, RV/TLV, RVBWR, total bilirubin, or INR. SFS-remnants with RV/TLV < 30% and non-SFS-remnants with RV/TLV ≥ 30% showed no significant differences either. RV and RVBWR for non-MHV (n = 59) and MHV-containing (n = 12) remnants were 550 ± 95 mL and 0.79 ± 0.1 mL vs 568 ± 97 mL and 0.79 ± 0.13, respectively (P = 0.423 and P = 0.919. Mean left RV/TLV was 35.8% ± 3.9%. Non-MHV (n = 59) and MHV-containing (n = 12) remnants (34.1% ± 3% vs 36% ± 4% respectively, P = 0.148. Eight SFS-remnants with RVBWR < 0.65 had a significantly smaller RV/TLV than 63 non-SFS-remnants with RVBWR ≥ 0.65 [SFS: RV/TLV 32.4% (range: 28%-35.7%) vs non-SFS: RV/TLV 36.2% (range: 26.1%-45.5%), P < 0.009. Six SFS-remnants with RV/TLV < 30% had significantly smaller RVBWR than 65 non-SFS-remnants with RV/TLV ≥ 30% (0.65 (range: 0.6-0.7) vs 0.8 (range: 0.6-1.27), P < 0.01. Two (2.8%) donors developed reversible liver failure. RVBWR and RV/TLV were concordant in 25%-33% of SFS and in 92%-94% of non-SFS remnants. MHV management options including complete MHV vs MHV-4A selective retention were necessary in n = 12 vs n = 2 remnants based on particularly risky congestive and non-congestive volume constellations.

CONCLUSION:

MHV procurement should consider individual remnant congestive- and non-congestive volume components and anatomy characteristics, RVBWR-RV/TLV constellation enables the identification of marginally small remnants.

• Authors: Arnold Radtke, George Sgourakis, Ernesto P Molmenti, Susanne Beckebaum, Vito R Cicinnati, Hartmut Schmidt, Heinz-Otto Peitgen, Christoph E Broelsch, Massimo Malagó, Tobias Schroeder
• Journal: World journal of gastroenterology (World J Gastroenterol) Vol. 21 Issue 19 Pg. 6008-17 (May 21 2015) ISSN: 2219-2840 [Electronic] United States
• PMID: 26019467 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Female
• Hepatectomy (adverse effects, methods)
• Hepatic Veins (physiopathology, surgery)
• Humans
• Hyperemia (diagnosis, etiology, physiopathology)
• Liver (blood supply, diagnostic imaging, surgery)
• Liver Circulation
• Liver Failure (diagnosis, etiology)
• Liver Transplantation (adverse effects, methods)
• Living Donors
• Male
• Middle Aged
• Multidetector Computed Tomography
• Organ Size
• Predictive Value of Tests
• Prospective Studies
• Risk Factors
• Treatment Outcome