Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany.
Am J Surg. 2010 May;199(5):708-15. doi: 10.1016/j.amjsurg.2009.03.024. Epub 2010 Jan 15.
The aim of this study was to delineate an algorithm for donor and recipient criteria and middle hepatic vein (MHV) management in right-graft live-donor liver transplantation (LDLT) on the basis of computerized 3-dimensional computed tomographic image analysis.
Data on 94 consecutive right-graft LDLTs were prospectively collected. Graft and remnant data for the first 23 cases were retrospectively evaluated by means of 3-dimensional computed tomographic reconstructions, and on the basis of that preliminary series, a graft selection algorithm using 3 parameters-hepatic vein dominance classification, graft and remnant graft volume/body weight ratios, and congestion volumes-was created. It was subsequently applied to the next 71 right-graft LDLTs.
Fifty-nine right grafts contained the MHV. Four of the 12 grafts with no MHVs required MHV reconstructions. In 18 cases, small liver grafts were used. The postoperative function of liver grafts and remnants with versus without MHVs was not statistically different.
The proposed algorithm favored the inclusion of the MHV with the right grafts. It also allowed for the procurement of grafts that were potentially small for size without compromising donor or recipient safety.
本研究旨在基于计算机三维 CT 图像分析，为右半肝供体肝移植（LDLT）制定供体和受体标准以及中肝静脉（MHV）处理的算法。
前瞻性收集了 94 例连续右半肝 LDLT 的数据。对前 23 例的移植物和残肝数据进行了三维 CT 重建的回顾性评估，并基于该初步系列，创建了一个使用 3 个参数-肝静脉优势分类、移植物和残肝体积/体重比以及充血体积-的供体选择算法。随后将其应用于接下来的 71 例右半肝 LDLT。
59 个右半肝包含 MHV。12 个无 MHV 的移植物中有 4 个需要进行 MHV 重建。18 例使用了小肝移植物。有或没有 MHV 的肝移植物和残肝的术后功能无统计学差异。
所提出的算法有利于将 MHV 纳入右半肝供体。它还允许获取可能较小的供体肝而不危及供体或受体的安全。
