Ann Surg Treat Res.  2023 Jun;104(6):348-357. 10.4174/astr.2023.104.6.348.

Hepatic venous territory mapping in living donor liver transplantation using right liver graft: an objective parameter for venous reconstruction

• Yang J
• Rhu J
• Kwon J
• Choi GS
• Kim JM
• Jeong WK
• Joh JW

• KMID: 2542799
• DOI: http://doi.org/10.4174/astr.2023.104.6.348

Abstract

Purpose
This study evaluated the clinical implication of hepatic venous territory mapping in living donor liver transplantation.
Methods
Living donor liver transplantations performed using right graft since 2017 were included. Hepatic venous volume mapping was started in 2019. Risk factors for graft failure and overall survival were analyzed. Analysis for factors related to occlusion of reconstructed vein was performed.
Results
Among 445 patients included, 213 underwent hepatic venous mapping. Hepatic venous mapping itself was not a significant factor for graft (hazard ratio [HR], 0.958; 95% confidence interval [CI], 0.441–2.082; P = 0.913) and overall survival (HR, 0.627; 95% CI, 0.315–1.247; P = 0.183). Inferior hepatic vein occlusion was a significant risk factor for both graft survival (HR, 8.795; 95% CI, 1.628–47.523; P = 0.012) and overall survival (HR, 11.13; 95% CI, 2.460–50.300; P = 0.002). In a subgroup with middle hepatic vein reconstruction, occlusion was a significant risk factor for overall survival (HR, 3.289; 95% CI, 1.304–8.296; P = 0.012). In patients with middle hepatic vein reconstruction whose venous territory volumes were measured, right anterior volume of ≥300 cm ³ was protective for vein occlusion (OR, 0.317; 95% CI, 0.152–0.662; P = 0.002). In patients with V5 reconstruction, V5 volume of ≥150 cm ³ was protective for vein occlusion (OR, 0.253; 95% CI, 0.087–0.734; P = 0.011).
Conclusion
Inferior and middle hepatic vein reconstruction has significant impact on clinical outcome. Hepatic venous territory mapping can provide an objective measure for successful reconstruction of venous branches.

Keyword

Hepatic veins; Liver transplantation; Middle hepatic vein reconstruction

Figure

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  Fig. 1 Technical steps for hepatic venous territory mapping. Using the Volume viewer in the AW server (GE Healthcare), (A) hepatic parenchyma is 3-dimensionally mapped and volume is calculated excluding the volume of major vessels. (B) As the hepatic venous branches are labeled, (C) it is combined with the parenchyma to divide the districts based on the venous territories. IHV, inferior hepatic vein; RHV, right hepatic vein.

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  Fig. 2 Kaplan-Meier (A) graft survival and (B) overall survival curves according to the status of inferior hepatic vein (IHV) using right hemi-liver in living donor liver transplantation.

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  Fig. 3 Kaplan-Meier (A) graft survival and (B) overall survival curves according to the status of reconstructed middle hepatic vein (MHV) in a subgroup of patients with MHV reconstruction.

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