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Computer-Assisted Operative Planning in Adult Living Donor Liver Transplantation: A New Way to Resolve the Dilemma of the Middle Hepatic Vein

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Abstract

An adequate venous outflow is essential for securing viability of both graft and remnant in adult living donor liver transplantation (ALDLT). Seventy-five potential live liver donors were evaluated for LDLT by means of an “all-in-one” CT, which defined the biliary tree, portal vein, hepatic artery, and hepatic vein anatomy. The acquired data sets were further analysed by means of the software HepaVision (MeVis, Germany). Only a minority (29%) of potential donors were found to have a vascular and biliary anatomy consistent with the classically described “normal” patterns. The vast majority (71%) had “anatomical variations”. Thirty-nine (52%) donors underwent ALDLT hepatectomy. The right hepatic vein was dominant in 64 cases, representing 48 ± 6% of the total liver volume (TLV). The middle hepatic vein was dominant in 11 cases, making up 40 ± 8% of the TLV. The left hepatic vein was never dominant. The volume contribution of the middle hepatic vein (MHV) was 114–782 ml for the right and 87–419 ml for the left hemiliver. Computer-assisted planning allows for the 3D reconstruction of the vascular and biliary anatomy, automatic calculation of the total and territorial liver volumes, and risk analysis of hepatic vein dominance relationships. This comprehensive data acquisition supports preoperative evaluation and provides a high degree of safety for donors and improved outcomes for recipients.

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ACKNOWLEDGEMENT

This study was supported by a grant from the German Society for Research: Nr: 117/1-1:A2.2.

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Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstrasse 55, D-45122, Essen, Germany

    A. Radtke MD, S. Nadalin MD, G. C. Sotiropoulos MD, E. P. Molmenti MD, C. Valentin-Gamazo, H. Lang MD, M. Bockhorn MD, C. E. Broelsch MD, FACS & M. Malagó MD

  2. Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany

    T. Schroeder MD

  3. MeVis Center for Medical Diagnostic Systems and Visualization, University of Bremen, Bremen, Germany

    H.O. Peitgen PhD

Authors
  1. A. Radtke MD
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  2. S. Nadalin MD
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  3. G. C. Sotiropoulos MD
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  4. E. P. Molmenti MD
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  5. T. Schroeder MD
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  6. C. Valentin-Gamazo
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  7. H. Lang MD
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  8. M. Bockhorn MD
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  9. H.O. Peitgen PhD
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  10. C. E. Broelsch MD, FACS
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  11. M. Malagó MD
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Corresponding author

Correspondence to M. Malagó MD.

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Radtke, A., Nadalin, S., Sotiropoulos, G.C. et al. Computer-Assisted Operative Planning in Adult Living Donor Liver Transplantation: A New Way to Resolve the Dilemma of the Middle Hepatic Vein. World J. Surg. 31, 175–185 (2007). https://doi.org/10.1007/s00268-005-0718-1

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  • DOI: https://doi.org/10.1007/s00268-005-0718-1

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