Imaging-based analysis of right inferior accessory hepatic vein variations in living donors: relevance to operative decision-making and graft outcomes.

AIM: Variations in the anatomy of the right inferior accessory hepatic vein (IRHV), particularly in their presence and size are known to influence hepatic venous dominance and the need for middle hepatic vein (MHV) reconstruction. Understanding these variations is crucial for optimising surgical planning and ensuring graft survival. This study aims to analyse IRHV variations using multidetector computer tomography (MDCT) in live liver donors and assess their impact on hepatic venous dominance and the need for MHV reconstruction to mitigate posttransplant complications.

MATERIALS AND

METHODS

A prospective analysis of 200 live liver donors was conducted using MDCT to assess liver volumetry, IRHV variations, and hepatic venous dominance. Statistical analyses, including Pearson's correlation and chi-square tests, were employed to evaluate the relationships among IRHV types, venous dominance patterns, and posttransplant complications.

RESULTS

IRHV was present in 41% of cases with 21.5% classified as type II (<4 mm) and 19.5% as type III (>4 mm). A statistically significant inverse correlation was observed between right hepatic vein (RHV) and IRHV diameters (Pearson's coefficient = -0.382, P<.05). In 84.6% of type III IRHV cases, MHV was dominant over RHV, highlighting the need for MHV reconstruction to prevent graft congestion. Although graft survival rates were lower in type III IRHV cases (69.2%) compared to type I (83.9%), this difference was not statistically significant (P=.106).

CONCLUSION

IRHV variations significantly affect hepatic venous dominance, particularly in type III IRHV cases, which require MHV reconstruction to ensure adequate venous drainage and prevent graft congestion. Accurate identification of variations in donors is a critical step in surgical planning and minimising posttransplant complications.