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Article: Tailoring donor hepatectomy per segment 4 venous drainage in right lobe live donor liver transplantation

TitleTailoring donor hepatectomy per segment 4 venous drainage in right lobe live donor liver transplantation
Authors
Issue Date2004
PublisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www3.interscience.wiley.com/cgi-bin/jtoc/106570021
Citation
Liver Transplantation, 2004, v. 10 n. 6, p. 755-762 How to Cite?
AbstractIncluding the middle hepatic vein (MHV) in the right lobe liver graft for adult-to-adult live donor liver transplantation provides more functional liver by securing adequate venous drainage. Donor outcome of this procedure in relation to different venous drainage patterns of segment 4 is unknown. Modification of graft harvesting technique by preserving segment 4b hepatic vein (V4b) in theory compensates for unfavorable venous drainage patterns. Consecutive 120 right lobe live donors were included. Computed tomography was studied in detail to assign each donor to one of the three types of the Nakamura classification of venous drainage pattern of segment 4. Type I drainage was mainly via the left hepatic vein (LHV), type II drainage was equally into the MHV and LHV, and type III drainage was predominantly into the MHV. Any distinct umbilical vein was also noted. In the early part of the series, the V4b draining into the MHV was divided to provide a long MHV stump in the graft. In the later part of the series, prominent V4b draining into the MHV was preserved in the donor as far as possible. Donor outcomes were measured by peak values of prothrombin time (PT), serum bilirubin and transaminases levels. There was no donor mortality. Type I donors (n=69) had the best outcome with peak PT of 17.9 sec (range 12.3-23.3 sec). Type II donors (n=44) had peak PT of 18.5 sec (range 15.4-24.4 sec). When V4b was preserved in type II donors (n=19), the peak PT (18.0 sec, range 15.4-20.7 sec) became significantly lower than that of type II donors who had V4b sacrificed (20.3 sec, range 16.2-24.4 sec) (P=0.001). A distinct umbilical vein (n=91, 75.8%) was insignificant for donor outcome measured by peak PT. Multivariate analysis identified that type II donors with V4b sacrificed (n=25), type III donors (n=7), and the first 50 cases had less favorable outcomes. In conclusion, unfavorable venous drainage patterns were one of the independent factors compromising postoperative donor liver function, but was circumvented by preservation of V4b. Copyright © 2004 by the American Association for the Study of Liver Diseases.
Persistent Identifierhttp://hdl.handle.net/10722/84271
ISSN
2015 Impact Factor: 3.951
2015 SCImago Journal Rankings: 1.763
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorChan, SCen_HK
dc.contributor.authorLo, CMen_HK
dc.contributor.authorLiu, CLen_HK
dc.contributor.authorWong, Yen_HK
dc.contributor.authorFan, STen_HK
dc.contributor.authorWong, Jen_HK
dc.date.accessioned2010-09-06T08:50:58Z-
dc.date.available2010-09-06T08:50:58Z-
dc.date.issued2004en_HK
dc.identifier.citationLiver Transplantation, 2004, v. 10 n. 6, p. 755-762en_HK
dc.identifier.issn1527-6465en_HK
dc.identifier.urihttp://hdl.handle.net/10722/84271-
dc.description.abstractIncluding the middle hepatic vein (MHV) in the right lobe liver graft for adult-to-adult live donor liver transplantation provides more functional liver by securing adequate venous drainage. Donor outcome of this procedure in relation to different venous drainage patterns of segment 4 is unknown. Modification of graft harvesting technique by preserving segment 4b hepatic vein (V4b) in theory compensates for unfavorable venous drainage patterns. Consecutive 120 right lobe live donors were included. Computed tomography was studied in detail to assign each donor to one of the three types of the Nakamura classification of venous drainage pattern of segment 4. Type I drainage was mainly via the left hepatic vein (LHV), type II drainage was equally into the MHV and LHV, and type III drainage was predominantly into the MHV. Any distinct umbilical vein was also noted. In the early part of the series, the V4b draining into the MHV was divided to provide a long MHV stump in the graft. In the later part of the series, prominent V4b draining into the MHV was preserved in the donor as far as possible. Donor outcomes were measured by peak values of prothrombin time (PT), serum bilirubin and transaminases levels. There was no donor mortality. Type I donors (n=69) had the best outcome with peak PT of 17.9 sec (range 12.3-23.3 sec). Type II donors (n=44) had peak PT of 18.5 sec (range 15.4-24.4 sec). When V4b was preserved in type II donors (n=19), the peak PT (18.0 sec, range 15.4-20.7 sec) became significantly lower than that of type II donors who had V4b sacrificed (20.3 sec, range 16.2-24.4 sec) (P=0.001). A distinct umbilical vein (n=91, 75.8%) was insignificant for donor outcome measured by peak PT. Multivariate analysis identified that type II donors with V4b sacrificed (n=25), type III donors (n=7), and the first 50 cases had less favorable outcomes. In conclusion, unfavorable venous drainage patterns were one of the independent factors compromising postoperative donor liver function, but was circumvented by preservation of V4b. Copyright © 2004 by the American Association for the Study of Liver Diseases.en_HK
dc.languageengen_HK
dc.publisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www3.interscience.wiley.com/cgi-bin/jtoc/106570021en_HK
dc.relation.ispartofLiver Transplantationen_HK
dc.rightsLiver Transplantation. Copyright © John Wiley & Sons, Inc.en_HK
dc.rightsSpecial Statement for Preprint only Before publication: 'This is a preprint of an article accepted for publication in [The Journal of Pathology] Copyright © ([year]) ([Pathological Society of Great Britain and Ireland])'. After publication: the preprint notice should be amended to follows: 'This is a preprint of an article published in [include the complete citation information for the final version of the Contribution as published in the print edition of the Journal]' For Cochrane Library/ Cochrane Database of Systematic Reviews, add statement & acknowledgement : ‘This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 20XX, Issue X. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.’ Please include reference to the Review and hyperlink to the original version using the following format e.g. Authors. Title of Review. Cochrane Database of Systematic Reviews 20XX, Issue #. Art. No.: CD00XXXX. DOI: 10.1002/14651858.CD00XXXX (insert persistent link to the article by using the URL: http://dx.doi.org/10.1002/14651858.CD00XXXX) (This statement should refer to the most recent issue of the Cochrane Database of Systematic Reviews in which the Review published.)-
dc.subject.meshHepatectomy - adverse effects - methods-
dc.subject.meshHepatic Veins - physiopathology-
dc.subject.meshLiver Transplantation-
dc.subject.meshLiving Donors-
dc.subject.meshTissue and Organ Harvesting - adverse effects - methods-
dc.titleTailoring donor hepatectomy per segment 4 venous drainage in right lobe live donor liver transplantationen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=1527-6465&volume=10&issue=6&spage=755&epage=762&date=2004&atitle=Tailoring+donor+hepatectomy+per+segment+4+venous+drainage+in+right+lobe+live+donor+liver+transplantationen_HK
dc.identifier.emailChan, SC: chanlsc@hkucc.hku.hken_HK
dc.identifier.emailLo, CM: chungmlo@hkucc.hku.hken_HK
dc.identifier.emailFan, ST: stfan@hku.hken_HK
dc.identifier.emailWong, J: jwong@hkucc.hku.hken_HK
dc.identifier.authorityChan, SC=rp01568en_HK
dc.identifier.authorityLo, CM=rp00412en_HK
dc.identifier.authorityFan, ST=rp00355en_HK
dc.identifier.authorityWong, J=rp00322en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1002/lt.20114en_HK
dc.identifier.pmid15162470-
dc.identifier.scopuseid_2-s2.0-2942718869en_HK
dc.identifier.hkuros88432en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-2942718869&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume10en_HK
dc.identifier.issue6en_HK
dc.identifier.spage755en_HK
dc.identifier.epage762en_HK
dc.identifier.isiWOS:000221728300009-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridChan, SC=7404255575en_HK
dc.identifier.scopusauthoridLo, CM=7401771672en_HK
dc.identifier.scopusauthoridLiu, CL=7409789712en_HK
dc.identifier.scopusauthoridWong, Y=7403041884en_HK
dc.identifier.scopusauthoridFan, ST=7402678224en_HK
dc.identifier.scopusauthoridWong, J=8049324500en_HK

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