Blood Supply of Caudate Lobe and Its Significance in Transplantation of Liver

Abstract

Introduction: Liver is divided into eight functionally independent segments according to the Couinaud classification. These segments maintain their independent vascular inflow, outflow, and biliary drainage. Caudate lobe (segment I of liver) enables independent segments resection for transplantation. The main goal of liver transplantation is to achieve a graft with adequate volume, portal and arterial inflow, and efficient biliary drainage. Before doing liver transplantation, one should be well-versed with its vascular supply. At present, the right lobe is becoming popular for liver transplantation, whereas caudate lobe is also a substantial choice. This research is an attempt to study the blood supply of caudate lobe to highlight its role in transplantation. Materials and methods: Microdissection of 50 caudate lobes was studied for morphometrical and arteriovenous analysis using piecemeal dissection in the Department of Anatomy, North Delhi Municipal Cooperation Medical College and Hindu Rao Hospital, New Delhi and Army College of Medical Sciences, New Delhi. Results: On morphological analysis, the caudate lobe was found to be variable in shape, having notches and processes. Out of the 50 livers, 72% of cases represented deep notches up to 3–5 mm, and papillary process was seen only in 42% of cases. On piecemeal dissection, we observed that caudate lobe receives its blood supply mainly from left branch whereas caudate process is from right branch of portal vein (PV). The caudate lobe drains independently through hepatic vein to inferior vena cava (IVC). Hepatic vein was present on dorsal surface of caudate lobe; hence, it can be called a dorsal hepatic vein. However, there is no irregularity noticed in arteriobiliary pattern. Conclusion: The vascular supply indicates that caudate lobe is an independent lobe and can also be used in transplant for pediatric cases and in adults with lower liver disease score and in combination with left lobe of liver.

Keywords

• anatomic independence
• caudate lobe
• liver transplantation
• spiegel's lobe