Selection of Appropriate Graft Directed by Venous Drainage Types of Median Hepatic Lobe in Adult-to-Adult Living Donor Liver Transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Yongjun ¹ , SHEN Baiyong ¹ , CHEN Hao ¹ , ZHAN Qian ¹ , LI Weixia ² , LI Hongwei ¹ , PENG Chenghong ¹

1.Department of General Surgery/Center of Organ Transplantation, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China;;
2.Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China;

Corresponding author：

Keywords：

Adult-to-adult living donor liver transplantation; Middle hepatic vein; Donor; Median hepatic lobe; Graft

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To discuss venous drainage types of median hepatic lobe and their guiding significances on the selection of grafts.
Methods Between April 2005 and March 2009, 109 potential living donors underwent 3-dimensional reconstruction of computed tomography (CT) and the volume of graft was determined in the center of organ transplantation of Ruijin Hospital. The venous drainage types of median hepatic lobe of each donor were analyzed by the computer-based liver operation-planning system in detail to assign middle hepatic vein (MHV) types according to Marcos classification and venous types of Ⅳb segment according to Nakamura classification. Results The branching pattern of MHV was divided into 3 types: Type Ⅰ and Ⅱwere relatively more accounting for 44.0% （48/109）, 37.6% （41/109）, and type Ⅲ was fewest 〔18.3% （20/109）〕. There were no significant differences in volume of whole liver, volume of left liver or left liver/total liver volume ratio among various types of MHV of the donor (P gt;0.05). Ⅳb vein was also divided into 3 types: The most common was type Ⅰ, accounting for 72.4% (79/109); Type Ⅱ 〔12.8% （14/109）〕, type Ⅲ 〔14.7% （16/109）〕 were relatively fewer. At last, 37 donors provided right liver, for Marcos Ⅰ, Ⅱ, and Ⅲ type of donors, donors remained with MHV was 12/17, 8/11, and 5/9; for Nakamura Ⅰ, Ⅱ, and Ⅲ type of donors, those number were 16/26, 4/6, and 5/5. Conclusion In adult-to-adult living donor liver transplantation, there may be great significances in accordance with Marcos and Nakamura typing results to harvest right lobe liver graft with or without MHV.

Citation： CHEN Yongjun ,SHEN Baiyong,CHEN Hao,ZHAN Qian,LI Weixia,LI Hongwei,PENG Chenghong. Selection of Appropriate Graft Directed by Venous Drainage Types of Median Hepatic Lobe in Adult-to-Adult Living Donor Liver Transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(5): 420-424. doi: Copy

1.	Ichida T, Matsunami H, Kawasaki S, et al. Living related-donor liver transplantation from adult to adult for primary biliary cirrhosis [J]. Ann Intern Med, 1995; 122(4): 275-276.
2.	Lo CM, Fan ST, Liu CL, et al. Extending the limit on the size of adult recipient in living donor liver transplantation using extended right lobe graft [J]. Transplantation, 1997; 63(10): 1524-1528.
3.	Fujita S, Kim ID, Uryuhara K, et al. Hepatic grafts from live donors: donor morbidity for 470 cases of live donation [J]. Transpl Int, 2000; 13(5): 333-339.
4.	Abecassis M, Adams M, Adams P, et al. Live Organ Donor Consensus Group. Consensus statement on the live organ donor [J]. JAMA, 2000; 284(22): 2919-2926.
5.	Fan ST. Live donor liver transplantation in adults [J]. Tr-ansplantation, 2006; 82(6): 723-732.
6.	Trotter JF, Wachs M, Everson GT, et al. Adult-to-adult transplantation of the right hepatic lobe from a living donor [J]. N Engl J Med, 2002; 346(14): 1074-1082.
7.	Inomata Y, Uemoto S, Asonuma K, et al. Right lobe graft in living donor liver transplantation [J]. Transplantation, 2000; 69(2): 258-264.
8.	Tanaka K, Ogura Y. “Small-for-size graft” and “small-for-size syndrome” in living donor liver transplantation [J]. Yonsei Med J, 2004; 45(6): 1089-1094.
9.	Kido M, Ku Y, Fukumoto T, et al. Significant role of middle hepatic vein in remnant liver regeneration of right-lobe living donors [J]. Transplantation, 2003; 75(9): 1598-1600.
10.	李卫侠，林晓珠，柴维敏，等. 多层螺旋CT测量肝脏体积的准确性 [J]. 中华放射学杂志， 2008; 42(5): 460-463.
11.	李卫侠，林晓珠，柴维敏，等. MSCT肝脏体积测量研究 [J]. 临床放射学杂志， 2008; 27(11): 1512-1515.
12.	方驰华，吴东波，黄燕鹏，等. 螺旋CT扫描数据的虚拟辅助性部分原位肝移植手术 [J]. 中国普外基础与临床杂志， 2008; 15(10): 729-732.
13.	Marcos A, Orloff M, Mieles L, et al. Functional venous anatomy for right-lobe grafting and techniques to optimize outflow [J]. Liver Transpl, 2001; 7(10): 845-852.
14.	Nakamura S, Tsuzuki T. Surgical anatomy of the hepatic veins and the inferior vena cava [J]. Surg Gynecol Obstet, 1981; 152(1): 43-50.
15.	Lee SG, Park KM, Hwang S, et al. Adult-to-adult living donor liver transplantation at the Asan Medical Center, Korea [J]. Asian J Surg, 2002; 25(4): 277-284.
16.	Sugawara Y, Makuuchi M, Sano K, et al. Vein reconstruction in modified right liver graft for living donor liver transplantation [J]. Ann Surg, 2003; 237(2): 180-185.
17.	Radtke A, Nadalin S, Sotiropoulos GC, et al. Computer-assisted operative planning in adult living donor liver transplantation: a new way to resolve the dilemma of the middle hepatic vein [J]. World J Surg, 2007; 31(1): 175-185.
18.	Kaneko T, Sugimoto H, Hirota M, et al. Intrahepatic venous anastomosis formation of the right liver in living donor liver transplantation: evaluations by Doppler ultrasonography and pulse-inversion ultrasonography with Levovist [J]. Surgery, 2005; 138(1): 21-27.
19.	Fan ST, Lo CM, Liu CL, et al. Safety and necessity of including the middle hepatic vein in the right lobe graft in adult-to-adult live donor liver transplantation [J]. Ann Surg, 2003; 238(1): 137-148.
20.	黄洁夫. 我国活体供肝肝移植发展面临的挑战和应对措施 [J]. 中华外科杂志, 2008; 46(3): 161-162.
21.	Li FG, Yan LN, Zeng Y, et al. Donor safety in adult living donor liver transplantation using the right lobe: single center experience in China [J]. World J Gastroenterol, 2007; 13(27): 3752-3755.
22.	Shin JH, Sung KB, Yoon HK, et al. Endovascular stent placement for interposed middle hepatic vein graft occlusion after living-donor liver transplantation using right-lobe graft [J]. Liver Transpl, 2006; 12(2): 269-276.
23.	Lo CM, Fan ST, Liu CL, et al. Hepatic venoplasty in living-donor liver transplantation using right lobe graft with middle hepatic vein [J]. Transplantation, 2003; 75(3): 358-360.
24.	陈拥军，彭承宏，沈柏用，等. 成人间活体肝移植供体行改良扩大右半肝切除的安全性 [J]. 外科理论与实践， 2008； 13(4): 316-321.
25.	Hwang S, Lee SG, Choi ST, et al. Hepatic vein anatomy of the medial segment for living donor liver transplantation using extended right lobe graft [J]. Liver Transpl， 2005; 11(4): 449-455.
26.	Chan SC, Lo CM, Liu CL, et al. Tailoring donor hepatectomy per segment 4 venous drainage in right lobe live donor liver transplantation [J]. Liver Transpl， 2004; 10(6): 755-762.

1. Ichida T, Matsunami H, Kawasaki S, et al. Living related-donor liver transplantation from adult to adult for primary biliary cirrhosis [J]. Ann Intern Med, 1995; 122(4): 275-276.
2. Lo CM, Fan ST, Liu CL, et al. Extending the limit on the size of adult recipient in living donor liver transplantation using extended right lobe graft [J]. Transplantation, 1997; 63(10): 1524-1528.
3. Fujita S, Kim ID, Uryuhara K, et al. Hepatic grafts from live donors: donor morbidity for 470 cases of live donation [J]. Transpl Int, 2000; 13(5): 333-339.
4. Abecassis M, Adams M, Adams P, et al. Live Organ Donor Consensus Group. Consensus statement on the live organ donor [J]. JAMA, 2000; 284(22): 2919-2926.
5. Fan ST. Live donor liver transplantation in adults [J]. Tr-ansplantation, 2006; 82(6): 723-732.
6. Trotter JF, Wachs M, Everson GT, et al. Adult-to-adult transplantation of the right hepatic lobe from a living donor [J]. N Engl J Med, 2002; 346(14): 1074-1082.
7. Inomata Y, Uemoto S, Asonuma K, et al. Right lobe graft in living donor liver transplantation [J]. Transplantation, 2000; 69(2): 258-264.
8. Tanaka K, Ogura Y. “Small-for-size graft” and “small-for-size syndrome” in living donor liver transplantation [J]. Yonsei Med J, 2004; 45(6): 1089-1094.
9. Kido M, Ku Y, Fukumoto T, et al. Significant role of middle hepatic vein in remnant liver regeneration of right-lobe living donors [J]. Transplantation, 2003; 75(9): 1598-1600.
10. 李卫侠，林晓珠，柴维敏，等. 多层螺旋CT测量肝脏体积的准确性 [J]. 中华放射学杂志， 2008; 42(5): 460-463.
11. 李卫侠，林晓珠，柴维敏，等. MSCT肝脏体积测量研究 [J]. 临床放射学杂志， 2008; 27(11): 1512-1515.
12. 方驰华，吴东波，黄燕鹏，等. 螺旋CT扫描数据的虚拟辅助性部分原位肝移植手术 [J]. 中国普外基础与临床杂志， 2008; 15(10): 729-732.
13. Marcos A, Orloff M, Mieles L, et al. Functional venous anatomy for right-lobe grafting and techniques to optimize outflow [J]. Liver Transpl, 2001; 7(10): 845-852.
14. Nakamura S, Tsuzuki T. Surgical anatomy of the hepatic veins and the inferior vena cava [J]. Surg Gynecol Obstet, 1981; 152(1): 43-50.
15. Lee SG, Park KM, Hwang S, et al. Adult-to-adult living donor liver transplantation at the Asan Medical Center, Korea [J]. Asian J Surg, 2002; 25(4): 277-284.
16. Sugawara Y, Makuuchi M, Sano K, et al. Vein reconstruction in modified right liver graft for living donor liver transplantation [J]. Ann Surg, 2003; 237(2): 180-185.
17. Radtke A, Nadalin S, Sotiropoulos GC, et al. Computer-assisted operative planning in adult living donor liver transplantation: a new way to resolve the dilemma of the middle hepatic vein [J]. World J Surg, 2007; 31(1): 175-185.
18. Kaneko T, Sugimoto H, Hirota M, et al. Intrahepatic venous anastomosis formation of the right liver in living donor liver transplantation: evaluations by Doppler ultrasonography and pulse-inversion ultrasonography with Levovist [J]. Surgery, 2005; 138(1): 21-27.
19. Fan ST, Lo CM, Liu CL, et al. Safety and necessity of including the middle hepatic vein in the right lobe graft in adult-to-adult live donor liver transplantation [J]. Ann Surg, 2003; 238(1): 137-148.
20. 黄洁夫. 我国活体供肝肝移植发展面临的挑战和应对措施 [J]. 中华外科杂志, 2008; 46(3): 161-162.
21. Li FG, Yan LN, Zeng Y, et al. Donor safety in adult living donor liver transplantation using the right lobe: single center experience in China [J]. World J Gastroenterol, 2007; 13(27): 3752-3755.
22. Shin JH, Sung KB, Yoon HK, et al. Endovascular stent placement for interposed middle hepatic vein graft occlusion after living-donor liver transplantation using right-lobe graft [J]. Liver Transpl, 2006; 12(2): 269-276.
23. Lo CM, Fan ST, Liu CL, et al. Hepatic venoplasty in living-donor liver transplantation using right lobe graft with middle hepatic vein [J]. Transplantation, 2003; 75(3): 358-360.
24. 陈拥军，彭承宏，沈柏用，等. 成人间活体肝移植供体行改良扩大右半肝切除的安全性 [J]. 外科理论与实践， 2008； 13(4): 316-321.
25. Hwang S, Lee SG, Choi ST, et al. Hepatic vein anatomy of the medial segment for living donor liver transplantation using extended right lobe graft [J]. Liver Transpl， 2005; 11(4): 449-455.
26. Chan SC, Lo CM, Liu CL, et al. Tailoring donor hepatectomy per segment 4 venous drainage in right lobe live donor liver transplantation [J]. Liver Transpl， 2004; 10(6): 755-762.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Selection of Appropriate Graft Directed by Venous Drainage Types of Median Hepatic Lobe in Adult-to-Adult Living Donor Liver Transplantation

Abstract Full text Figures/Tables Video References Cited by

Format

Content