医学
肝移植
静脉
后备箱
门静脉血栓形成
下腔静脉
移植
肝切除术
外科
活体肝移植
狭窄
血栓形成
解剖
放射科
生态学
切除术
生物
作者
Sadhana Shankar,Ashwin Rammohan,Vasanthakumar Gunasekaran,Gomathy Narasimhan,Rajesh Rajalingam,Kumar Palaniappan,Rathnavel Kanagavelu,Akila Rajakumar,Ilankumaran kaliamoorthy,Mohamed Rela
标识
DOI:10.1016/j.ajt.2023.03.004
摘要
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.
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