Bevezetés: A felnőtt élődonoros májtranszplantáció a cadaver donorok hiánya miatt a transzplantáció, a szervnyerés egyik alternatív útja. Élődonorok kapcsán a recipiensnek adott kellő volumenű, súlyú graft mellett a donor biztonsága, szövődménymentes gyógyulása a fő cél. A középső vena hepatica, a speciális anatómiai helyzetéből fakadóan, jelentős dilemmát okoz. Az anatómiai jobb májlebenyek transzplantációjakor felmerül a középső vena hepatica S5 és S8-hoz futó ágainak rekonstrukciója. Célkitűzés: A szerzők célja a középső vena hepatica rekonstrukciós igényének anatómiai alapokon történő vizsgálata, illetve a portalis és vénás be-, kiáramlási fenomének leírása volt. Módszer: 130 élődonoros transzplantációban részt vett donor májanatómiai sajátosságait elemezték a MeVis szoftver segítségével. Bevezetésre került az úgynevezett portohepaticus aránytalanságot jelző szám (shift). Eredmények: Az esetek 64,6%-ában jobb vena hepatica dominancia volt jellemző, a bal vena hepatica sohasem volt domináns. A V5 és V8 területe közösen a jobb májlebeny 33,2±8,9%-a volt. A portalis territórium és vénás lefedettség korrelációi a következők voltak: bal lebenyben R2 = 0,7811, a középső vena hepaticához tartozó területen: R² = 0,5463 és a jobb vena hepaticához tartozó területen: R² = 0,5843. A shift átlagos értéke 28,2% volt. Következtetések: A vena portae és vena hepatica be- és kiáramlási mintázatában látható különbségek befolyással lehetnek a középső vena hepatica rekonstrukciójának kérdésére. Orv. Hetil., 2013, 154, 1417–1425.
Annual data report of the US Organ Procurement and Transplantation Network (OPTN) and the Scientific Registry of Transplant Recipients (SRTR). Introduction. Am. J. Transplant., 2013, 13 (Suppl. 1), 8–10.
Annual data report of the US Organ Procurement and Transplantation Network (OPTN) and the Scientific Registry of Transplant Recipients (SRTR). Preface. Am. J. Transplant., 2013, 13 (Suppl. 1), 1–7.
Singer, P. A., Siegler, M., Whitington, P. F., et al.: Ethics of liver transplantation with living donors. N. Engl. J. Med., 1989, 321, 620–622.
Whitington P. F. , 'Ethics of liver transplantation with living donors ' (1989 ) 321 N. Engl. J. Med. : 620 -622 .
Trotter, J. F., Adam, R., Lo, C. M., et al.: Documented deaths of hepatic lobe donors for living donor liver transplantation. Liver Transplant., 2006, 12, 1485–1488.
Lo C. M. , 'Documented deaths of hepatic lobe donors for living donor liver transplantation ' (2006 ) 12 Liver Transplant. : 1485 -1488 .
Bismuth, H.: Surgical anatomy and anatomical surgery of the liver. World J. Surg., 1982, 6, 3–9.
Bismuth H. , 'Surgical anatomy and anatomical surgery of the liver ' (1982 ) 6 World J. Surg. : 3 -9 .
Couinaud, C.: Study of the intrahepatic portal vein. Presse Med., 1953, 61, 1434–1438.
Couinaud C. , 'Study of the intrahepatic portal vein ' (1953 ) 61 Presse Med. : 1434 -1438 .
Goldsmith, N. A., Woodburne, R. T.: The surgical anatomy pertaining to liver resection. Surg. Gynecol. Obstet., 1957, 105, 310–318.
Woodburne R. T. , 'The surgical anatomy pertaining to liver resection ' (1957 ) 105 Surg. Gynecol. Obstet. : 310 -318 .
Couinaud, C.: Liver anatomy: portal (and suprahepatic) or biliary segmentation. Dig. Surg., 1999, 16, 459–467.
Couinaud C. , 'Liver anatomy: portal (and suprahepatic) or biliary segmentation ' (1999 ) 16 Dig. Surg. : 459 -467 .
Strasberg, S. M.: Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J. Hepatobiliary Pancreat Surg., 2005, 12, 351–355.
Strasberg S. M. , 'Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system ' (2005 ) 12 J. Hepatobiliary Pancreat Surg. : 351 -355 .
Fischer, L., Cardenas, C., Thorn, M., et al.: Limits of Couinaud’s liver segment classification: a quantitative computer-based three-dimensional analysis. J. Comput. Assist. Tomogr., 2002, 26, 962–967.
Thorn M. , 'Limits of Couinaud’s liver segment classification: a quantitative computer-based three-dimensional analysis ' (2002 ) 26 J. Comput. Assist. Tomogr. : 962 -967 .
Radtke, A., Schroeder, T., Sotiropoulos, G. C., et al.: Anatomical and physiological classification of hepatic vein dominance applied to liver transplantation. Eur. J. Med. Res., 2005, 10, 187–194.
Sotiropoulos G. C. , 'Anatomical and physiological classification of hepatic vein dominance applied to liver transplantation ' (2005 ) 10 Eur. J. Med. Res. : 187 -194 .
Kasahara, M., Takada, Y., Fujimoto, Y., et al.: Impact of right lobe with middle hepatic vein graft in living-donor liver transplantation. Am. J. Transplant., 2005, 5, 1339–1346.
Fujimoto Y. , 'Impact of right lobe with middle hepatic vein graft in living-donor liver transplantation ' (2005 ) 5 Am. J. Transplant. : 1339 -1346 .
Frericks, B. B., Kirchhoff, T. D., Shin, H. O., et al.: Preoperative volume calculation of the hepatic venous draining areas with multi-detector row CT in adult living donor liver transplantation: impact on surgical procedure. Eur. Radiol., 2006, 16, 2803–2810.
Shin H. O. , 'Preoperative volume calculation of the hepatic venous draining areas with multi-detector row CT in adult living donor liver transplantation: impact on surgical procedure ' (2006 ) 16 Eur. Radiol. : 2803 -2810 .
Radtke, A., Nadalin, S., Sotiropoulos, G. C., et al.: Computer-assisted operative planning in adult living donor liver transplantation: a new way to resolve the dilemma of the middle hepatic vein. World J. Surg., 2007, 31, 175–185.
Sotiropoulos G. C. , 'Computer-assisted operative planning in adult living donor liver transplantation: a new way to resolve the dilemma of the middle hepatic vein ' (2007 ) 31 World J. Surg. : 175 -185 .
Radtke, A., Sgourakis, G., Sotiropoulos, G. C., et al.: Territorial belonging of the middle hepatic vein in living liver donor candidates evaluated by three-dimensional computed tomographic reconstruction and virtual liver resection. Br. J. Surg., 2009, 96, 206–213.
Sotiropoulos G. C. , 'Territorial belonging of the middle hepatic vein in living liver donor candidates evaluated by three-dimensional computed tomographic reconstruction and virtual liver resection ' (2009 ) 96 Br. J. Surg. : 206 -213 .
Kiuchi, T., Kasahara, M., Uryuhara, K., et al.: Impact of graft size mismatching on graft prognosis in liver transplantation from living donors. Transplantation, 1999, 67, 321–327.
Uryuhara K. , 'Impact of graft size mismatching on graft prognosis in liver transplantation from living donors ' (1999 ) 67 Transplantation : 321 -327 .
Ogura, Y., Hori, T., El Moghazy, W. M., et al.: Portal pressure <15 mm Hg is a key for successful adult living donor liver transplantation utilizing smaller grafts than before. Liver Transpl., 2010, 16, 718–728.
Moghazy W. M. , 'Portal pressure <15 mm Hg is a key for successful adult living donor liver transplantation utilizing smaller grafts than before ' (2010 ) 16 Liver Transpl. : 718 -728 .
Yamaoka, Y., Washida, M., Honda, K., et al.: Liver transplantation using a right lobe graft from a living related donor. Transplantation, 1994, 57, 1127–1130.
Honda K. , 'Liver transplantation using a right lobe graft from a living related donor ' (1994 ) 57 Transplantation : 1127 -1130 .
Malago, M., Molmenti, E. P., Paul, A., et al.: Hepatic venous outflow reconstruction in right live donor liver transplantation. Liver Transpl., 2005, 11, 364–365.
Paul A. , 'Hepatic venous outflow reconstruction in right live donor liver transplantation ' (2005 ) 11 Liver Transpl. : 364 -365 .
Cattral, M. S., Greig, P. D., Muradali, D., et al.: Reconstruction of middle hepatic vein of a living-donor right lobe liver graft with recipient left portal vein. Transplantation, 2001, 71, 1864–1866.
Muradali D. , 'Reconstruction of middle hepatic vein of a living-donor right lobe liver graft with recipient left portal vein ' (2001 ) 71 Transplantation : 1864 -1866 .
Kim, B. W., Park, Y. K., Paik, O. J., et al.: Effective anatomic reconstruction of the middle hepatic vein in modified right lobe graft living donor liver transplantation. Transplant. Proc., 2007, 39, 3228–3233.
Paik O. J. , 'Effective anatomic reconstruction of the middle hepatic vein in modified right lobe graft living donor liver transplantation ' (2007 ) 39 Transplant. Proc. : 3228 -3233 .
Shi, X. M., Tao, Y. F., Fu, Z. R., et al.: Reconstruction of the middle hepatic vein tributary in adult right lobe living donor liver transplantation. Hepatobiliary Pancreat. Dis. Int., 2011, 10, 581–586.
Fu Z. R. , 'Reconstruction of the middle hepatic vein tributary in adult right lobe living donor liver transplantation ' (2011 ) 10 Hepatobiliary Pancreat. Dis. Int. : 581 -586 .
Soejima, Y., Shimada, M., Suehiro, T., et al.: Reconstruction of the middle hepatic vein tributaries using the recipient’s recanalized umbilical vein in right-lobe living-donor liver transplantation. Surgery, 2006, 139, 442–445.
Suehiro T. , 'Reconstruction of the middle hepatic vein tributaries using the recipient’s recanalized umbilical vein in right-lobe living-donor liver transplantation ' (2006 ) 139 Surgery : 442 -445 .
Heizmann, O., Zidowitz, S., Bourquain, H., et al.: Assessment of intraoperative liver deformation during hepatic resection: prospective clinical study. World J. Surg., 2010, 34, 1887–1893.
Bourquain H. , 'Assessment of intraoperative liver deformation during hepatic resection: prospective clinical study ' (2010 ) 34 World J. Surg. : 1887 -1893 .
Nakamura, S., Tsuzuki, T.: Surgical anatomy of the hepatic veins and the inferior vena cava. Surg. Gynecol. Obstet., 1981, 152, 43–50.
Tsuzuki T. , 'Surgical anatomy of the hepatic veins and the inferior vena cava ' (1981 ) 152 Surg. Gynecol. Obstet. : 43 -50 .
Asakuma, M., Fujimoto, Y., Bourquain, H., et al.: Graft selection algorithm based on congestion volume for adult living donor liver transplantation. Am. J. Transplant., 2007, 7, 1788–1796.
Bourquain H. , 'Graft selection algorithm based on congestion volume for adult living donor liver transplantation ' (2007 ) 7 Am. J. Transplant. : 1788 -1796 .
Hiroshige, S., Nishizaki, T., Soejima, Y., et al.: Beneficial effects of 3-dimensional visualization on hepatic vein reconstruction in living donor liver transplantation using right lobe graft. Transplantation, 2001, 72, 1993–1996.
Soejima Y. , 'Beneficial effects of 3-dimensional visualization on hepatic vein reconstruction in living donor liver transplantation using right lobe graft ' (2001 ) 72 Transplantation : 1993 -1996 .
Yonemura, Y., Taketomi, A., Soejima, Y., et al.: Validity of preoperative volumetric analysis of congestion volume in living donor liver transplantation using three-dimensional computed tomography. Liver Transpl., 2005, 11, 1556–1562.
Soejima Y. , 'Validity of preoperative volumetric analysis of congestion volume in living donor liver transplantation using three-dimensional computed tomography ' (2005 ) 11 Liver Transpl. : 1556 -1562 .
Sano, K., Makuuchi, M., Miki, K., et al.: Evaluation of hepatic venous congestion: proposed indication criteria for hepatic vein reconstruction. Ann. Surg., 2002, 236, 241–247.
Miki K. , 'Evaluation of hepatic venous congestion: proposed indication criteria for hepatic vein reconstruction ' (2002 ) 236 Ann. Surg. : 241 -247 .
Sano, K., Makuuchi, M., Takayama, T., et al.: Technical dilemma in living-donor or split-liver transplant. Hepato-gastroenterology, 2000, 47, 1208–1209.
Takayama T. , 'Technical dilemma in living-donor or split-liver transplant ' (2000 ) 47 Hepato-gastroenterology : 1208 -1209 .
Hwang, S., Lee, S. G., Park, K. M., et al.: Hepatic venous congestion in living donor liver transplantation: preoperative quantitative prediction and follow-up using computed tomography. Liver Transplant., 2004, 10, 763–770.
Park K. M. , 'Hepatic venous congestion in living donor liver transplantation: preoperative quantitative prediction and follow-up using computed tomography ' (2004 ) 10 Liver Transplant. : 763 -770 .
Hwang, S., Lee, S. G., Kim, K. H., et al.: Intraoperative assessment of hepatic venous congestion with direct clamping of the hepatic vein trunk for living donor liver transplantation. Transplant. Proc., 2004, 36, 1462–1465.
Kim K. H. , 'Intraoperative assessment of hepatic venous congestion with direct clamping of the hepatic vein trunk for living donor liver transplantation ' (2004 ) 36 Transplant. Proc. : 1462 -1465 .
Cui, D., Kiuchi, T., Egawa, H., et al.: Microcirculatory changes in right lobe grafts in living-donor liver transplantation: a near-infrared spectrometry study. Transplantation, 2001, 72, 291–295.
Egawa H. , 'Microcirculatory changes in right lobe grafts in living-donor liver transplantation: a near-infrared spectrometry study ' (2001 ) 72 Transplantation : 291 -295 .
Kinkhabwala, M. M., Guarrera, J. V., Leno, R., et al.: Outflow reconstruction in right hepatic live donor liver transplantation. Surgery, 2003, 133, 243–250.
Leno R. , 'Outflow reconstruction in right hepatic live donor liver transplantation ' (2003 ) 133 Surgery : 243 -250 .
Satou, S., Sugawara, Y., Kokudo, N., et al.: Preoperative detection of hepatic venous collaterals in right liver graft. Liver Transpl., 2005, 11, 708–709.
Kokudo N. , 'Preoperative detection of hepatic venous collaterals in right liver graft ' (2005 ) 11 Liver Transpl. : 708 -709 .
Lasinski, W., Zientarski, B.: The anastomotic system of sub-hepatic veins in man. Bull. Assoc. Anat. (Nancy), 1976, 60, 559–566.
Zientarski B. , 'The anastomotic system of sub-hepatic veins in man ' (1976 ) 60 Bull. Assoc. Anat. (Nancy) : 559 -566 .