The Institute of Liver Disease and Transplantation, Dr Rela Institute, and Medical Centre, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India; Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.
The Institute of Liver Disease and Transplantation, Dr Rela Institute, and Medical Centre, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
Am J Transplant. 2023 Jun;23(6):786-793. doi: 10.1016/j.ajt.2023.03.004. Epub 2023 Mar 10.
Anatomical variations of left hepatic vein are observed in nearly a third of left lateral segment (LLS) donors in living donor liver transplantation. However, there is a paucity of studies and no structured algorithm for customized outflow reconstruction in LLS grafts with variant anatomy. Analysis of a prospectively collected database of 296 LLS pediatric living donor liver transplantation was done to identify different venous drainage patterns of segments 2 (V2) and 3 (V3). Left hepatic vein anatomy was classified into 3 types: type 1 (n = 270, 91.2%): V2 and V3 joined to form a common trunk which drains into the middle hepatic vein/inferior vena cava (IVC), subtype 1a length of trunk ≥9 mm and subtype 1b length of trunk <9 mm; 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 middle hepatic vein respectively. Analysis of postoperative outcomes between LLS grafts with single and reconstructed multiple outflows showed no difference in the occurrence of hepatic vein thrombosis/stenosis, major morbidity (P = .91), and 5-year survival (log-rank P = .562). This classification is a simple yet effective tool for preoperative donor assessment, and we propose a schema for the customized reconstruction of LLS grafts with excellent and consistently reproducible outcomes.
在活体肝移植中，左外侧叶（LLS）供体中近三分之一存在左肝静脉解剖变异。然而，对于解剖变异的 LLS 移植物，目前研究较少，也没有针对流出道重建的结构化算法。本研究对 296 例 LLS 小儿活体肝移植的前瞻性数据库进行了分析，以确定 2 段（V2）和 3 段（V3）的不同静脉引流模式。左肝静脉解剖分为 3 种类型：1 型（n = 270，91.2%）：V2 和 V3 汇合成一个共同的干，然后汇入肝中静脉/下腔静脉（IVC），亚型 1a 主干长度≥9mm，亚型 1b 主干长度<9mm；2 型（n = 6，2%）：V2 和 V3 分别独立汇入 IVC；3 型（n = 20，6.8%）：V2 和 V3 分别汇入 IVC 和肝中静脉。对单流出道和重建多流出道 LLS 移植物术后结果的分析表明，肝静脉血栓形成/狭窄、主要并发症（P =.91）和 5 年生存率（对数秩 P =.562）无差异。这种分类是术前供体评估的一种简单而有效的工具，我们提出了一种用于 LLS 移植物重建的方案，其效果出色且可重复性好。
