Pravisani Riccardo, Soyama Akihiko, Takatsuki Mitsuhisa, Hidaka Masaaki, Adachi Tomohiko, Ono Shinichiro, Hara Takanobu, Hamada Takashi, Kanetaka Kengo, Eguchi Susumu
From the Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Exp Clin Transplant. 2019 Aug;17(4):529-535. doi: 10.6002/ect.2018.0155. Epub 2019 Apr 17.
Hepatic venous congestion is associated with impaired graft regeneration in living-donor liver transplant, and the management of middle hepatic vein tributaries in the right lobe graft represents an unresolved issue. In this study, we aimed to investigate the precise outflow pattern of segments 5 and 8 between the right hepatic vein and middle hepatic vein and the respective regeneration rates after living-donor liver transplant with right lobe graft, as available data on these relevant topics are scarce.
We conducted a retrospective analysis of computed tomography scans with 3-dimensional simulation, vessel reconstruction, and volume measurement of 38 right lobe grafts without middle hepatic vein. Follow-up time was 3 months after living-donor liver transplant.
In donors, segments 5 and 8 measured 141.9 ± 48.8 mL (21.0% of graft volume) and 230.4 ± 52.5 mL (34.3% of graft volume), respectively, with significant difference between volumes (P < .01). Percentage of segmental venous drainage in segment 5 was 55.5 ± 17.2% for the middle hepatic vein and 41.0 ± 20.9% for the right hepatic vein; drainage in segment 8 was 46.4 ± 13.2% for the middle hepatic vein and 52.9 ± 13.2% for the right hepatic vein. The outflow pattern was significantly different between segments for both veins (P = .01 for middle hepatic vein and P < .01 for right hepatic vein), showing that segment 5 was statistically more dependent on the middle hepatic vein and segment 8 was more dependent on the right hepatic vein. For living-donor liver transplant recipients, the prevalence of middle hepatic vein tributary reconstruction was 39.5%. At 3-month follow-up, the regeneration rate for the posterior sector was 85.8 ± 39.9%, whereas rates for segments 5 and 8 were 33.4 ± 39.7% and 68.4 ± 41.0%, respectively (P < .01).
In living-donor liver transplant with right lobe graft and without middle hepatic vein, segment 5 is the most vulnerable graft area for impaired regeneration. Segments 5 and 8 should be evaluated independently on the basis of their respective outflow patterns to more precisely plan the outflow management and patient outcomes.
肝静脉淤血与活体肝移植中移植物再生受损相关，右叶移植物中肝静脉分支的处理仍是一个未解决的问题。在本研究中，我们旨在探讨右肝静脉和中肝静脉之间第5和第8段的精确流出模式，以及右叶移植物活体肝移植后的各自再生率，因为关于这些相关主题的现有数据很少。
我们对38例无中肝静脉的右叶移植物进行了计算机断层扫描的回顾性分析，包括三维模拟、血管重建和体积测量。随访时间为活体肝移植后3个月。
在供体中，第5和第8段的体积分别为141.9±48.8 mL（占移植物体积的21.0%）和230.4±52.5 mL（占移植物体积的34.3%），体积之间存在显著差异（P<.01）。第5段中肝静脉的节段性静脉引流百分比为55.5±17.2%，右肝静脉为41.0±20.9%；第8段中肝静脉的引流百分比为46.4±13.2%，右肝静脉为52.9±13.2%。两条静脉各节段的流出模式均有显著差异（中肝静脉P=.01，右肝静脉P<.01），表明第5段在统计学上更依赖于中肝静脉，第8段更依赖于右肝静脉。对于活体肝移植受者，中肝静脉分支重建的发生率为39.5%。在3个月的随访中，后段的再生率为85.8±39.9%，而第5和第第8段的再生率分别为33.4±39.7%和68.4±41.0%（P<.01）。
在无中肝静脉的右叶移植物活体肝移植中，第5段是再生受损最易受累的移植物区域。应根据第5和第8段各自的流出模式进行独立评估，以更精确地规划流出管理和患者预后。
