Use of 3-Dimensional Computed Hepatic Venous Visualization for Graft Outflow Venoplasty in Adult Left Living-Donor Liver Transplant

Abstract

Objectives: A surgeon must be aware of hepatic vascular variations to safely perform living-donor liver transplant. The ramification patterns of the hepatic veins with tributaries for left lobe graft outflow venoplasty should be evaluated preoperatively with 3-dimensional computed tomography of the donor.

Materials and Methods: Twenty-four potential donors were examined between October 1999 and July 2006 for living-donor liver transplant using the left lobe. They underwent triphasic helical computed tomography of the liver on a multidetector helical computed tomographic scanner. All images, including 2-dimensional reformation and 3-dimensional reconstructed models with maximum intensity projection and volume rendering, were sent to a workstation for postprocessing.

Results: The ramification patterns of the left and middle hepatic vein were classified into 2 groups; they formed a common trunk (type 1), which had 3 variations; type 1A (13 cases): in which the left hepatic vein and the middle hepatic vein without any tributaries on their confluence; type 1B (8 cases): in which there was venous confluence in the left hepatic vein with the left superficial vein and middle hepatic vein; type 1C (2 cases): in which the hepatic venous confluence in the left hepatic vein and middle hepatic vein and the left superficial vein directly joining into the inferior vena cava; type 2 (1 case) had the left hepatic vein and middle hepatic vein joining into the inferior vena cava separately; type 1B underwent 2 venoplasty procedures, but the others underwent only a single venoplasty.

Conclusions: We demonstrated the anatomic interrelation of the hepatic veins for hepatic outflow venoplasty of adult left lobe living-donor liver transplant with 3-dimensional computed tomography scanning to help surgeons preoperatively determine the appropriate technique or form of reconstruction.