Liver Transplantation | 2019
Anatomical Pitfall in Right Posterior Sector Graft Procurement in Living Donor Liver Transplantation
Abstract
Right posterior sector graft (RPSG) procurement is an alternative procedure to hemi-lobe graft harvest in living-donor liver transplantation to resolve graft-size disparity and secure donor s safety. However, the procedure has not been standardized because of the infrequent indication and surgical difficulties. We present a case of RPSG in which the recipient developed primary graft dysfunction due to insufficient functional graft volume. The estimated graft-recipient weight ratio (GRWR) was 0.66% according to the preoperative computed tomography volumetry. However, it was based only on the right hepatic vein (RHV) and inferior vena cava (IVC) as a landmark. The distribution of the anterior segmental branches of the portal vein in the RPSG accounted for 31.3% of the estimated graft volume. The functional GRWR was only 0.45% and significantly lower than the required GRWR that is as low as 0.6% with portal venous modulation at our institution. The proximal RHV is located in segment 8, and peripheral glissonian branches from the anterior segment override the RHV. Following this case, the estimated functional GRWR of the RPSG was maintained above 0.6%, and RPSG usage did not directly lead to small-for-size syndrome in all cases. Conclusion: Functional graft volume in an RPSG should be evaluated based on not only the RHV and IVC but also portal perfusion.