Live donor liver transplantation

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Live donor liver transplantation Elizabeth A. Pomfret, James J. Pomposelli, Roger L. Jenkins Journal of Hepatology Volume 34, Issue 4, Pages 613-624 (April 2001) DOI: 10.1016/S0168-8278(01)00031-9

Fig. 1 Schematic representation of donor right hepatectomy and graft implantation. Simultaneous procedures utilizing two operative teams minimizes graft ischemic time and improves outcome. Journal of Hepatology 2001 34, 613-624DOI: (10.1016/S0168-8278(01)00031-9)

Fig. 2 (A–C) Donor evaluation occurs in three phases. (A) Phase I: donors undergo preliminary screening with blood typing and liver function tests. (B) Phase II: includes volumetric CT scan and complete medical and psychosocial evaluation. (C) Phase III: acceptable donors undergo celiac arteriogram and the recipient is reassessed to ensure that they are medically suitable for transplant. Journal of Hepatology 2001 34, 613-624DOI: (10.1016/S0168-8278(01)00031-9)

Fig. 3 (A–D) Volumetric CT scan with three-dimensional renderings provides excellent preoperative images to plan resection planes and to anticipate vascular anomalies. (A) Shows right lobe liver volume calculated after virtual resection plane. Right and inferior right hepatic veins in orange and middle and left hepatic veins in pink. Some variations in donor hepatic vein (B) and portal vein (C) anatomy are shown. (D) Arterial anatomy is confirmed with celiac angiography. Journal of Hepatology 2001 34, 613-624DOI: (10.1016/S0168-8278(01)00031-9)

Fig. 4 (A,B) CT rendering and intraoperative picture of right and inferior right hepatic vein branches. Inferior right hepatic vein branches requiring reimplantation (>5 mm) are observed in the majority of donors. Journal of Hepatology 2001 34, 613-624DOI: (10.1016/S0168-8278(01)00031-9)

Fig. 5 An example of a donor rejected for unsafe anatomy. Lack of a dominant hepatic vein draining the right lobe of the liver would necessitate resecting the middle hepatic vein with the liver graft, leaving the donor with a small residual volume (essentially the left lateral segment). Journal of Hepatology 2001 34, 613-624DOI: (10.1016/S0168-8278(01)00031-9)

Fig. 6 CT image (A) and portal vein cast (B) of a donor exhibiting separate anterior and posterior branches of the right portal vein. Journal of Hepatology 2001 34, 613-624DOI: (10.1016/S0168-8278(01)00031-9)