Prevalence of the Scissural Vein in Living Liver Donor Candidates and Its Association with Hepatic Venous Variants: A Single-Center Retrospective Study

Objectives: The scissural vein is an independent venous structure arising from segment IV or the umbilical fissure and draining directly into the inferior vena cava (IVC) without joining the middle hepatic vein (MHV) or left hepatic vein (LHV). This study aimed to determine its prevalence in living liver donor candidates and evaluate its association with hepatic venous variants.
Methods: This single-center retrospective study included 248 consecutive adult living liver donor candidates evaluated between January 2020 and January 2026. Three-dimensional volumetric reconstructions from preoperative multiphase contrast-enhanced computed tomography (CT) were reviewed for surgically significant scissural veins (≥4 mm). The same ≥4 mm diameter threshold was applied to the inferior hepatic vein (IHV), V5, and V8, in accordance with institutional reconstruction practice and published literature. Associations between the scissural vein and demographic, volumetric, and venous variables were statistically analyzed.
Results: A scissural vein was identified in 70 of 248 candidates (28.2%). No significant differences were observed between candi-dates with and without a scissural vein regarding age, sex, BMI, hepatic steatosis, liver volumes, remnant liver percentage, GRWR, or the presence of an IHV ≥4 mm (OR 1.03; p=1.000). However, V5 and/or V8 ≥4 mm were significantly more frequent in the scis-sural vein-positive group (42.9% vs. 28.1%; OR 1.92, 95% CI 1.08–3.41; p=0.037), and this association remained significant after adjustment for age, BMI, and liver volume (adjusted OR 1.89, 95% CI 1.04–3.42; p=0.037). Hepatic steatosis was associated with BMI (p<0.001), but not with age (p=0.820).
Conclusion: A scissural vein was present in 28.2% of living donor candidates. It was not associated with liver volume, sex, or IHV presence but was independently associated with V5/V8. This finding may reflect a shared developmental pattern of the anterior/periscissural venous system and warrants further prospective investigation.

Keywords: Hepatic venous anatomy, middle hepatic vein, scissural vein, segment IV venous drainage, umbilical fissure vein, Living donor liver transplantation