Shankar S, Rammohan A, Gunasekaran V, Narasimhan G, Rajalingam R, Palaniappan K, Kanagavelu R, Rajakumar A, Kaliamoorthy I, Rela M. Anatomical Variations of Left Hepatic Vein and Outflow Reconstruction Techniques in Paediatric Living Donor Liver Transplantation.
Am J Transplant 2023:S1600-6135(23)00346-5. [PMID:
36906229 DOI:
10.1016/j.ajt.2023.03.004]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/19/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023]
Abstract
Anatomical variations of left hepatic vein (LHV) are observed in nearly a third of left lateral segment (LLS) donors in living donor liver transplantation (LDLT). There is paucity of studies and no structured algorithm for customised outflow reconstruction in LLS grafts with variant anatomy. Analysis of a prospectively collected database of 296 LLS paediatric LDLT was done to identify different venous drainage patterns of segments 2 (V2) and 3 (V3). LHV anatomy was classified into three types: type 1(n=270, 91.2%): V2 and V3 joined to form a common trunk which drains into middle hepatic vein (MHV)/inferior vena cava (IVC), subtype 1a length of trunk ≥ 9mm and subtype 1b length of trunk < 9mm; type 2(n=6, 2%): V2 and V3 drain independently into IVC; type 3(n=20, 6.8%): V2 and V3 drain into IVC and MHV respectively. Analysis of post-operative outcomes between LLS grafts with single and reconstructed multiple outflows showed no difference in the occurrence of hepatic vein thrombosis/stenosis, major morbidity (p 0.91) and 5 year survival (log rank p 0.562). This classification is a simple yet effective tool for pre-operative donor assessment and we propose a schema for customised reconstruction of LLS grafts, with excellent and consistently reproducible outcomes.
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