Evaluation of Hepatic Venous Congestion: Proposed Indication Criteria for Hepatic Vein Reconstruction

Overview

Journal Ann Surg

Specialty General Surgery

Date 2002 Aug 10

PMID 12170030

Citations 62

Authors

Keiji Sano

Masatoshi Makuuchi

Kenji Miki

Atsushi Maema

Yasuhiko Sugawara

Hiroshi Imamura

Hidetoshi Matsunami

Tadatoshi Takayama

Affiliations

Soon will be listed here.

Abstract

Objective: To establish criteria for venous reconstruction of middle hepatic vein (MHV) tributaries of the right liver graft in adult-to-adult living donor liver transplantation (LDLT).

Summary Background Data: In adult LDLT using the right hemiliver, the MHV is usually separated from the graft, which results in potential venous congestion in the major part of the right paramedian sector (segments 5 and 8). It is controversial whether MHV tributaries should be reconstructed.

Methods: Thirty-nine donors for LDLT were enrolled in the study. After liver transection, temporary arterial clamping was carried out to visualize congestion in the right paramedian sector by occlusion of MHV tributaries. Intra- and postoperative (on postoperative days 3 and 7) Doppler ultrasonography was performed to check the hepatic venous and portal flow in the veno-occlusive area.

Results: In 29 of 37 donors (78%), the liver surface of the veno-occlusive area was discolored with temporary arterial clamping. The discolored area was calculated to represent approximately two thirds of the right paramedian sector on computed tomography volumetry. All of the cases with discoloration exhibited absent venous flow and regurgitated portal flow in the discolored area by intraoperative Doppler ultrasonography. These ultrasonographic findings resolved by postoperative day 7 in 6 of 14 cases (43%).

Conclusions: The state of venous congestion in the right liver graft can be correctly assessed by the temporary arterial clamping method and intraoperative Doppler ultrasonography. If the venocongestive area is demonstrated to be so large that the graft volume excluding this area is thought to be insufficient for postoperative metabolic demand, venous reconstruction is recommended.

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References

Rousselot L, Grossi C, Slattery J, Rossi P, CONTE A, RUZICKA Jr F . TEMPORARY HEPATIC OUTFLOW BLOCK WITH HEPATIC ARTERY PERFUSION BY ANTICANCER AGENTS. Surg Gynecol Obstet. 1964; 118:1295-304. View

COUINAUD C, Nogueira C . [The hepatic veins in humans]. Acta Anat (Basel). 1958; 34(1-2):84-110. View

Kaneko T, Kaneko K, Sugimoto H, Inoue S, Hatsuno T, Sawada K . Intrahepatic anastomosis formation between the hepatic veins in the graft liver of the living related liver transplantation: observation by Doppler ultrasonography. Transplantation. 2000; 70(6):982-5. DOI: 10.1097/00007890-200009270-00018. View

Sano K, Makuuchi M, Takayama T, Sugawara Y, Imamura H, Kawarasaki H . Technical dilemma in living-donor or split-liver transplant. Hepatogastroenterology. 2000; 47(35):1208-9. View

Lee S, Park K, Hwang S, Lee Y, Choi D, Kim K . Congestion of right liver graft in living donor liver transplantation. Transplantation. 2001; 71(6):812-4. DOI: 10.1097/00007890-200103270-00021. View

Starzl T, Francavilla A, Halgrimson C, Francavilla F, Porter K, Brown T . The origin, hormonal nature, and action of hepatotrophic substances in portal venous blood. Surg Gynecol Obstet. 1973; 137(2):179-99. PMC: 2747591. View

Maguire R, Doppman J . Angiographic abnormalities in partial Budd-Chiari syndrome. Radiology. 1977; 122(3):629-35. DOI: 10.1148/122.3.629. View

LASINSKI W, Zientarski B . [The anastomotic system of sub-hepatic veins in man]. Bull Assoc Anat (Nancy). 1976; 60(170):559-66. View

JOBSIS F . Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters. Science. 1977; 198(4323):1264-7. DOI: 10.1126/science.929199. View

10.

Nakamura S, Tsuzuki T . Surgical anatomy of the hepatic veins and the inferior vena cava. Surg Gynecol Obstet. 1981; 152(1):43-50. View

11.

Bismuth H, Houssin D . Reduced-sized orthotopic liver graft in hepatic transplantation in children. Surgery. 1984; 95(3):367-70. View

12.

Pichlmayr R, Ringe B, Gubernatis G, Hauss J, Bunzendahl H . [Transplantation of a donor liver to 2 recipients (splitting transplantation)--a new method in the further development of segmental liver transplantation]. Langenbecks Arch Chir. 1988; 373(2):127-30. View

13.

Delpy D, Cope M, van der Zee P, Arridge S, Wray S, Wyatt J . Estimation of optical pathlength through tissue from direct time of flight measurement. Phys Med Biol. 1988; 33(12):1433-42. DOI: 10.1088/0031-9155/33/12/008. View

14.

Strong R, Lynch S, Ong T, Matsunami H, Koido Y, Balderson G . Successful liver transplantation from a living donor to her son. N Engl J Med. 1990; 322(21):1505-7. DOI: 10.1056/NEJM199005243222106. View

15.

Yamaoka Y, Washida M, Honda K, Tanaka K, Mori K, Shimahara Y . Liver transplantation using a right lobe graft from a living related donor. Transplantation. 1994; 57(7):1127-30. View

16.

Hashikura Y, Makuuchi M, Kawasaki S, Matsunami H, Ikegami T, Nakazawa Y . Successful living-related partial liver transplantation to an adult patient. Lancet. 1994; 343(8907):1233-4. DOI: 10.1016/s0140-6736(94)92450-3. View

17.

Kakazu T, Makuuchi M, Kawasaki S, Miyagawa S, Nakazawa Y, Kubota T . Reconstruction of the middle hepatic vein tributary during right anterior segmentectomy. Surgery. 1995; 117(2):238-40. DOI: 10.1016/s0039-6060(05)80093-5. View

18.

Urata K, Kawasaki S, Matsunami H, Hashikura Y, Ikegami T, Ishizone S . Calculation of child and adult standard liver volume for liver transplantation. Hepatology. 1995; 21(5):1317-21. View

19.

Murata S, Itai Y, ASATO M, Kobayashi H, Nakajima K, Eguchi N . Effect of temporary occlusion of the hepatic vein on dual blood in the liver: evaluation with spiral CT. Radiology. 1995; 197(2):351-6. DOI: 10.1148/radiology.197.2.7480676. View

20.

Lo C, Fan S, Liu C, Wei W, Lo R, Lai C . Adult-to-adult living donor liver transplantation using extended right lobe grafts. Ann Surg. 1997; 226(3):261-9; discussion 269-70. PMC: 1191019. DOI: 10.1097/00000658-199709000-00005. View