Study of the right hepatic veins based on autopsy and CT three-dimensional reconstruction for the application of right living donor liver transplantation

Purpose: To investigate the anatomy and variations of right hepatic veins (RHVs) for the right hepatic lobe partial living donor liver transplantation (LDLT) by autopsy and multidetector computed tomography (CT). Methods The livers of 50 Chinese adult cadavers were dissected and the hepatic veins of 100 normal subjects who underwent CT angiography in the hepatic venous phase with a 64-slice CT scanner were reconstructed. The anatomy and variations of RHVs and the venous drainage of the right half of the liver were observed. Results Two types and four subtypes of RHV were identified. Type Ⅰa was the most common type, which accounted for 64% of cadaveric livers and 63% of CT subjects. The beginning and ending of the main trunk of RHV were deeper than the middle section. The distance from the RHV flowing into IVC to the middle hepatic vein (MHV) flowing into IVC was less than 2 cm in 94% of cadaveric livers and 96% of CT subjects. The length between the RHV inflow into IVC and the nearest tributary (≥ 3 mm in diameter) was longer than 1 cm in 44.0% of cadaveric livers and 74.7% of CT subjects. Hepatic venous outflow of the right anterior sector primarily drained through the MHV. The incidence of accessory RHV (ARHV) with a minimal diameter of 5 mm was 32.0% in cadaveric livers and 28.0% in CT subjects. The diameter of the thickest ARHV in the liver was negatively correlated with the diameter of RHV. Conclusions Although the RHV is the main outflow vein of the right half of the liver in Chinese people, most of the right anterior sector is also drained through the MHV. The incidence of large ARHV is high. In the right hepatic lobe partial LDLT, the tributaries of MHV and the large ARHV should be reconstructed. CT three-dimensional reconstruction can well display the ARHV with surgical significance.