After right hepatectomy with the middle hepatic vein trunk for a graft, the venous outflow in segment IV is disturbed.
There are limited data regarding the effect of middle hepatic vein deprivation on liver regeneration or functional recovery.
In this study, investigators from Japan reviewed 2 groups of living donors.
Patients in group A underwent right hepatectomy with preservation of the middle hepatic vein, while those in group B were deprived of the middle hepatic vein.
If the donor was less than 50 years old, and the remnant left liver was estimated to be more than 35% of the whole liver, right liver graft harvesting with the middle hepatic vein trunk was considered.
The team assessed the volume regeneration of segments I to III, segment IV, and overall liver using computed tomography 3 months after surgery.
|Regeneration rate of segments I to III was significantly higher in group B.|
The investigators found that the regeneration rate of segment IV was significantly impaired in group B donors compared with group A (125% versus 45%).
However, the regeneration rate of segments I to III was significantly higher in group B (208% versus 263%).
They did not find any significant difference in the regeneration rate of the whole left liver or functional recovery between groups.
Multivariate analysis revealed that the resection type was a significant predictive factor for the regeneration rate of segments I to III and segment IV.
The investigators determined that when deprived of the middle hepatic vein, liver regeneration of segment IV was impaired but was compensated for by the regeneration of segments I to III.
Dr Shojiro Hata's team concluded, "Extended right hepatectomy can be safely performed with careful preoperative consideration using these criteria".