Influence of outflow‐obstructed liver volume and venous communication development: A three‐dimensional volume study in living donors

Abstract

Living donor liver transplantation using the left liver graft with the middle hepatic vein (MHV) is a well-established procedure. Following such procedures, outflow obstruction occurs in remnant livers. However, the effects of the outflow-obstructed liver volume (LV ), with or without venous communication development, remain unclear. The aim of the study is to investigate effects of outflow-obstructed regions by focusing on short-term outcomes and remnant liver hypertrophy in left liver procurement donors. Of 532 donors, we collected data from 119 undergoing left liver procurement with the MHV. Postoperative hepatic parameters, venous communication development, and liver hypertrophy were evaluated in 2 donor groups based on LV . The left liver was procured with the MHV in 119 donors, who formed 2 more groups based on the median LV : large-outflow-obstruction group (n = 60; LV ≥ 263 mL) and small-outflow-obstruction (n = 59; LV < 263 mL) group. Postoperative liver function parameters were significantly impaired in the large-outflow-obstruction group compared with the small-outflow-obstruction group. Postoperative venous communication developed in 52 (66.7%) of 78 donors analyzed. Hypertrophy ratios in remnant right livers and right paramedian sectors were significantly higher in the small-outflow-obstruction group than in the large-outflow-obstruction group (P = 0.01 and P = 0.02, respectively). The liver hypertrophy ratio of outflow-obstructed regions was better, especially in small regions developing venous communication (P = 0.001). The postoperative morbidity rate did not differ significantly (P = 0.66). In conclusion, the procurement of the left liver graft with the MHV was safely performed with minimal morbidity by assessing the donor remnant right liver volume with and without outflow obstruction. Attention should be paid that postoperative hepatic parameters and remnant liver hypertrophy were impaired in the remnant livers with large outflow-obstructed regions compared with those with small outflow-obstructed regions. Liver Transplantation 23 1531-1540 2017 AASLD.

Resection and reconstruction of the largest abdominal vein system (the inferior vena cava, hepatic, and portal vein): a narrative review

“…They showed that alanine transaminase had bimodal peaks at postoperative days 1 and 10 ( 50 ) and there was a positive correlation between the predicted congestion volume and total bilirubin level at postoperative day 5 ( 51 ). With regard to vein-to-vein communication between the right hepatic vein and the MHV after left liver procurement with the MHV, postoperative communication developed in 52 (66.7%) of 78 donors, which contributed to a better regeneration rate of the right paramedian sector ( 52 ).…”

Effects of Adding Congested Segment IV to the Left Lateral Graft on Short-term Outcomes in Pediatric Living-donor Liver-transplant Recipients

“…Most evaluations of liver function and regeneration of congested areas have been conducted and reported in the context of liver resection procedures, including donor surgery. [17][18][19][20] Few studies have evaluated the function and regeneration of congested areas following liver transplantation, i.e., their function and regeneration in recipient livers. The effects of cold storage and ischemia-reperfusion injury can be more profound in congested areas because shear stress can be more harmful as arterial blood with higher pressure flows into the portal vein in congested areas, while there is insufficient blood flow, especially in zone 3, because of venous obstruction.…”

Outflow Reconstruction Techniques in Living Donor Liver Transplantation

“…Many groups spend efforts to using left liver graft in order to not to compromising safety of the donor (16). In practice, full left lobe grafts include Couinaud segments 2, 3, and 4 with the MHV.…”