Anatomical and physiological classification of hepatic vein dominance applied to liver transplantation.

Abstract

BACKGROUND: Proper outflow reconstruction is essential in LDLT. Preoperative planning requires meticulous attention to hepatic vein dominance patterns. The purpose of our study was to provide a combined anatomical-physiological classification of hepatic vein dominance useful for surgical decision-making in both donors and recipients. METHODOLOGY: We analyzed 3-dimensional CT-imaging reconstructions of 55 potential live liver donors evaluated at our Institution between January 2003 and May 2004. RESULTS: Our data revealed that: 1) The middle hepatic vein (MHV) and left hepatic vein (LHV) show a relative lack of anatomical diversity, whereas the right hepatic vein (RHV) exhibits multiple variants, 2) 45% donors had inferior hepatic veins (IHV) with anatomically and physiologically relevant venous drainage territories, 3) The RHV is usually dominant when present as a single vein without anatomical IHV (type 1A), or when considered as a complex with IHV (type 1Bx) (80% vs. 88%), 4) Only 55% of dominant type 1Bx RHV/IHV-complex automatically included a dominant type 1By RHV by itself, 5) A single RHV out of anatomical complex with IHV (type 1By) was dominant in only 48% of our donor candidates, 6) The MHV types 2A and 2By are strongly dominant accounting for up to 57% of total liver volume (TLV). CONCLUSIONS: We propose a new classification based on both anatomical and physiological hepatic venous configurations. Our model also provides a new nomenclature that can be universally applied to preoperative planning in LDLT.