Role of CT angiography in defining the plane of transection in right lobe liver transplantation
Gupta, S.; Soin, A.S.; Jain, P.; Singh, A.; Singhal, D.; Somashekar, U.; Verma, V.; Kumar, M. and Nundy, S. (2002) Role of CT angiography in defining the plane of transection in right lobe liver transplantation. In: 7th Congress of Asian Society of Transplantation (CAST), 2002.
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Background: During donor liver transection, it is important not to have any ischaemic or congested segment in either the donor or the recipient. It is also important to preserve the venous outflow of segments 5 and 8. Methods: In four donors for right lobe liver transplantation we have used triple.phase spiral CT angiography to define the intrahepatic branches of the middle hepatic vein (MHV). CT angiography defines these branches accurately with our current imaging protocol. In addition, we use intraoperative US Doppler to mark the MHV. This along with temporary occlusion of the graft inflow aids in deciding the transection line. Results: In one donor, CT angiography did not define any dominant (>5mm) segment 5 and 8 outflow veins. After transection of the liver, there were congested areas in the graft cut edge in the donor and the recipient. In two other donors, CT angiography identified the dominant branches of segments 5 and 8 (one donor) and segment 8 alone (one) going to MHV, which were preserved and later reconstructed to avoid graft congestion. In the donor with only a dominant segment 8 branch, three tributaries joined to form a very short segment 8 vein. The plane of transection ran initially along the plane obtained after temporary vascular occlusion. Superiorly, the plane was modified to skirt just to the right of the marking of the MHV so that the segment 8 branch could be encircled as one vein. In the fourth donor, all the dominant branches drained into the right vein and after transection, there were no congested segments in the graft, hence obviating the need for venous reconstruction. Conclusions: CT angiography reliably identities segment 5 and 8 branches and sub-branches. It also defines the angle of entry and whether it is possible to obtain a single vein for later reconstruction by modifying the plane of transection. In the absence of any dominant segment 5 and 8 outflow to either the right or the middle hepatic veins, it may be prudent to include the middle hepatic vein in the right lobe graft.
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