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Segment 4 and the left lateral segment regeneration pattern after resection of the middle hepatic vein in a living donor right hepatectomy

Identifieur interne : 001344 ( Pmc/Corpus ); précédent : 001343; suivant : 001345

Segment 4 and the left lateral segment regeneration pattern after resection of the middle hepatic vein in a living donor right hepatectomy

Auteurs : Nir Lubezky ; Irina Oyfe ; Alan G. Contreras ; Juan P. Rocca ; Dianne Lapointe Rudow ; Tara Keegan ; Bashir Taouli ; Leona Kim-Schluger ; Sander Florman ; Thomas Schiano ; Marcelo Facciuto

Source :

RBID : PMC:4266443

Abstract

Background

Inclusion of the middle hepatic vein (MHV) with a right hepatectomy (RH) in live donor liver transplantation improves venous drainage of the anterior sector of the graft. Its long-term effects on donor left liver (LL) regeneration are not well described.

Methods

Donors who underwent RH with MHV (MHV+, n = 12) were compared with donors who underwent RH with preservation of the MHV (MHV–, n = 24). Peri-operative complications and volume of the entire liver and individual segments were evaluated at 1 year post-donation.

Results

There was a trend towards a higher complication rate in the MHV+ group (41% versus 25%), without reaching statistical significance (P = 0.3). Males, high body mass index (BMI) and a smaller residual liver volume (RLV) were predictors for greater LL regeneration. MHV+ donors had impaired regeneration of segment 4 (S4) at 1 year, and compensatory greater left lateral segment regeneration. The absence of venous drainage of S4 (V4) to left hepatic vein (LHV) was a predictor of impaired S4 regeneration.

Conclusions

Regeneration of S4 is impaired in MHV+ donors. Caution should be taken when considering MHV removal on donors with dominant S4, especially on those with potential increased demand for liver regeneration, such as males, higher BMI and a smaller RLV.


Url:
DOI: 10.1111/hpb.12303
PubMed: 25212437
PubMed Central: 4266443

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