Living Donor Liver Transplantation in Adults: Vascular Variants Important in Surgical Planning for Donors and Recipients
Nazli Erbay1,2,
Vassilios Raptopoulos1,
Elizabeth A. Pomfret3,
Ihab R. Kamel1,4 and
Jonathan B. Kruskal1
1 Department of Radiology, Beth Israel Deaconess Medical Center and Harvard
Medical School, 330 Brookline Ave., Boston, MA 02215.
2 Present address: Department of Radiology, Lahey Clinic Medical Center, 41 Mall
Rd., Burlington, MA 01805.
3 Institute of Transplantation, Lahey Clinic Medical Center, Burlington, MA
01805.
4 Present address: Russell H. Morgan Department of Radiology and Radiological
Sciences, Johns Hopkins Medical Center, 600 N. Wolfe St., Baltimore, MD
21287.
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Fig. 1. —60-year-old man with end-stage liver disease.
Maximum-intensity-projection CT scan obtained in oblique plane reveals
accessory right posterior hepatic artery (long solid arrow) arising
from superior mesenteric artery and replaced left hepatic artery (dotted
arrow) arising from left gastric artery. Common hepatic artery branches
into middle hepatic artery that supplies segment IV (short solid
arrow) and right anterior hepatic artery.
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Fig. 2. —33-year-old man with normal liver function who was candidate
for right-lobe liver donor to his father (shown in
Fig. 1).
Maximum-intensity-projection CT scan obtained in oblique plane shows replaced
right hepatic artery (arrow) arising from superior mesenteric artery.
Similar variant is seen on maximum-intensity-projection image of patient's
father (Fig. 1).
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Fig. 3. —26-year-old man with normal liver function who was candidate
for right-lobe liver donation. Maximum-intensity-projection CT scan obtained
in oblique plane shows common hepatic artery branching to gastroduodenal
artery (g), from which right posterior hepatic artery (rp) arises and
continues as right hepatic artery. Right hepatic artery is short, and it gives
rise to right anterior hepatic artery (ra) and then branches into left (lh)
and middle (mh) hepatic arteries. In this static image, right posterior
hepatic artery appears connected to right anterior hepatic artery, but no
connection was evident on other projections. Because hemihepatectomy and
transplantation would have required extensive arterial surgery, another more
suitable candidate was found.
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Fig. 4. —18-year-old woman with normal liver function who was
right-lobe donor candidate. Maximum-intensity-projection CT scan obtained in
coronal plane shows two accessory inferior right hepatic veins
(arrows) that drain to inferior vena cava at various distances from
junction of main right hepatic vein and inferior vena cava. Size and location
of accessory right hepatic veins needed to be evaluated for surgical
planning.
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Fig. 5. —28-year-old woman with normal liver function who was
right-lobe donor candidate. Thick-slab maximum-intensity-projection CT scan
obtained in axial plane reveals large early-branching vein (arrow)
draining right anterior superior segment (segment VIII) into middle hepatic
vein (m). Early-branching vein was reanastomosed to prevent congestion of
segment VIII in recipient.
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Fig. 6. —34-year-old man with normal liver function who was right-lobe
donor candidate. Surface-rendered CT scan shows absence of right portal vein,
resulting in trifurcation of main portal vein (mp) to left (lp), right
anterior (ra), and right posterior (rp) portal veins.
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Fig. 7. —26-year-old man with normal liver function who was right-lobe
donor candidate. Maximum-intensity-projection CT scan obtained in oblique
plane shows accessory right inferior portal vein (arrow) arising from
main portal vein. Main portal vein then bifurcates into left portal vein and
right portal vein.
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Copyright © 2003 by the American Roentgen Ray Society.
