Citation Information :
Dubey A, Dhuria R, Chowdhary R. Blood Supply of Caudate Lobe and Its Significance in Transplantation of Liver. Journal of Medical Academics 2024; 7 (1):3-7.
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.
She WH, Chok KS, Fung JY, et al. Outcomes of right-lobe and left-lobe living-donor liver transplantations using small-for-size grafts. World J Gastroenterol 2017;23(23):4270–4277. DOI: 10.3748/wjg.v23.i23.4270
Marcos A, Fisher RA, Ham JM, et al. Right lobe living donor liver transplantation. Transplantation 1999;68(6):798–803. DOI: 10.1097/00007890-199909270-00012
Vinayak N, Ravi M, Ankush G, et al. Dual graft living donor liver transplantation - a case report. BMC Surg 2019;19(1):149. DOI: 10.1186/s12893-019-0606-5
Makki K, Chorasiya V, Srivastava A, et al. Analysis of caudate lobe biliary anatomy and its implications in living donor liver transplantation - a single centre prospective study. Transpl Int 2018. DOI: 10.1111/tri.13272
Soejima Y, Shirabe K, Taketomi A, et al. Left lobe living donor liver transplantation in adults. Am J Transplant 2012;12(7):1877–1885. DOI: 10.1111/j.1600-6143.2012.04022.x
Eguchi S, Hibi T, Egawa H. Liver transplantation: Japanese contributions. J Gastroenterol 2018;53(9):1107–1108. DOI: 10.1007/s00535-018-1470-2
Kumon M, Kumon T, Tsutsui E, et al. Definition of the caudate lobe of the liver based on portal segmentation. Glob Health Med 2020;2(5):328–336. DOI: 10.35772/ghm.2020.01088
Dodds WJ, Erickson SJ, Taylor AJ, et al. Caudate lobe of the liver: anatomy, embryology, and pathology. Am J Roentgenol 1990;154(1):87–93. DOI: 10.2214/ajr.154.1.2104732
Murakami G, Hata F. Human liver caudate lobe and liver segment. Anat Sci Int 2002;77(4):211–224. DOI: 10.1046/j.0022-7722.2002.00033.x
Auh Y, Rosen A, Rubenstein W, et al. CT of the papillary process of the caudate lobe of the liver. Am J Roentgenol 1984;142(3):535–538. DOI: 10.2214/ajr.142.3.535
Sagoo MG, Aland RC, Gosden E. Morphology and morphometry of the caudate lobe of the liver in two populations. Anat Sci Int 2018;93(1):48–57. DOI: 10.1007/s12565-016-0365-7
Varma V, Mehta N, Kumaran V, et al. Indications and contraindications for liver transplantation. Int J Hepatol 2011;2011:121862. DOI: 10.4061/2011/121862
Ikegami T, Nishizaki T, Yanaga K, et al. Changes in the caudate lobe that is transplanted with extended left lobe liver graft from living donors. Surgery 2001;129(1):86–90. DOI: 10.1067/msy.2001.109499
HS Sarala, Thittamranahalli Kariyappa J, R S. Morphological variations of caudate lobe of the liver and their clinical implications. Int J Anat Res 2015;3(2):980–983. DOI: 10.16965/ijar.2015.119
Gilcrease-Garcia B, Fortin F. Papillary process of the caudate lobe. In 2018.
Dixit SG, Chauhan P. Absent caudate lobe of liver: anatomical and clinical relevance. Liver Int 2015;35(10):2338. DOI: 10.1111/liv.12926
Mao W, Jiang X, Cao Y, et al. A practical study of the hepatic vascular system anatomy of the caudate lobe. Quant Imaging Med Surg 2021;11(4):1313–1321. DOI: 10.21037/qims-20-780
Kogure K, Kuwano H, Fujimaki N, et al. Relation among portal segmentation, proper hepatic vein, and external notch of the caudate lobe in the human liver. Ann Surg 2000;231(2):223–228. DOI: 10.1097/00000658-200002000-00011