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Evaluation of the Compatibility of Preoperative MRCP and Intraoperative Cholangiography in Imaging of the Bile Ducts in Living Donor Liver Transplantation. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03342-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Cahalane AM, Mojtahed A, Sahani DV, Elias N, Kambadakone AR. Pre-hepatic and pre-pancreatic transplant donor evaluation. Cardiovasc Diagn Ther 2019; 9:S97-S115. [PMID: 31559157 DOI: 10.21037/cdt.2018.09.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Innovations in surgical techniques coupled with advances in medical and pharmacological management in the past few decades have enabled organ transplantation to become integral to the management of end stage organ failure. In this review article, we will review the role of the radiologist in the work up of liver and pancreas donors during evaluation of their donor candidacy. The critical role of imaging in assessing the parenchymal, biliary and vascular anatomy in liver donor candidates will be reviewed, as well as highlighting the anatomical findings that may pose a contraindication to transplantation. The limited role of imaging in pancreas donor evaluation is also covered, as well as a brief overview of the surgical techniques available and how the radiologist's findings influence operative technique selection.
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Affiliation(s)
- Alexis M Cahalane
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Amirkasra Mojtahed
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Dushyant V Sahani
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Nahel Elias
- Division of Transplant Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Avinash R Kambadakone
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
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Living Donor Liver Transplantation: Overview, Imaging Technique, and Diagnostic Considerations. AJR Am J Roentgenol 2019; 213:54-64. [PMID: 30973783 DOI: 10.2214/ajr.18.21034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE. The purpose of this article is to discuss the process of becoming a liver donor, describe the surgical methods used for transplantation, and critically review preoperative and intraoperative imaging techniques. CONCLUSION. Radiologists play a vital role in ensuring the safety of living liver donors; however, consensus guidelines do not exist for imaging protocol or reporting. Standardization would provide more consistent image quality across centers, improve communication with the transplant team, and facilitate data mining for quality assurance and research.
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Elsabbagh AM, Williams C, Girlanda R, Hawksworth J, Kroemer A, Matsumoto CS, Fishbein TM. The impact of intercenter sharing on the outcomes of pediatric split liver transplantation. Clin Transplant 2017; 31. [PMID: 29032604 DOI: 10.1111/ctr.13138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Split liver transplantation allows for expansion of the pool of organs available for pediatric liver transplantation. The impact of sharing segments of the same liver between centers has not been studied. STUDY DESIGN Retrospective analysis of 24 pediatric split liver transplant cases in a recent cohort. We evaluated the outcomes of pediatric recipients who shared organs with adult patients in our own center (group A) compared to recipients who shared organs with adult patients in other centers. (group B). RESULTS One-, 3-, and 5-year graft survival for group A was 100%, 100%, and 100% vs 83%, 71%, and 57% for group B (P = .039). Postoperative complications included biliary complications (41.7% in group A vs 50% in group B, P = .682), vascular complications (8.3% in group A vs 41.7% in group B, P = .059), and postoperative bleeding (16.7% in group A vs 25% in group B, P = .615). High-grade Clavien-Dindo complications were 0% in group A vs 33.3% in group B, P = .028. CONCLUSIONS Organ sharing between centers appears to be associated with significantly poorer graft survival. Possible explanations include greater procurement-related injury or suboptimal vessel distribution. Future larger studies focused on this area may be helpful to formulate policy considerations.
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Affiliation(s)
- Ahmed M Elsabbagh
- MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, United States
| | - Cassie Williams
- MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, United States
| | - Raffaele Girlanda
- MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, United States
| | - Jason Hawksworth
- MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, United States
| | - Alexander Kroemer
- MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, United States
| | - Cal S Matsumoto
- MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, United States
| | - Thomas M Fishbein
- MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, United States
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Santosh D, Goel A, Birchall IW, Kumar A, Lee KH, Patel VH, Low G. Evaluation of biliary ductal anatomy in potential living liver donors: comparison between MRCP and Gd-EOB-DTPA-enhanced MRI. Abdom Radiol (NY) 2017; 42:2428-2435. [PMID: 28474177 DOI: 10.1007/s00261-017-1157-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To compare magnetic resonance cholangiopancreatography (MRCP) and Gd-EOB-DTPA-enhanced MRI in the evaluation of the biliary anatomy in potential living liver donors (LLDs). METHODS A retrospective study was conducted in a tertiary care liver transplant center after obtaining ethics and institutional approvals. A total of 42 potential LLD MRI examinations were performed between November 2013 and March 2016. All patients underwent a standard MRI protocol which included MRCP and Gd-EOB-DTPA-enhanced MRI sequences in a single session. Three abdominal MR radiologists independently reviewed the studies and completed a customized data collection sheet for each MR sequence. The readers subjectively scored the bile duct visualization on each MR sequence on a Likert scale and classified the biliary anatomic configuration. Statistical analysis was performed using intraclass correlation coefficient and the McNemar Chi-square (χ 2) test. RESULTS The 42 potential LLDs included 22 males and 20 females with an age range of 18-60 years. There was 'good' or 'excellent' inter-reader agreement on either MRI examination for the visualization of the first- and second-order ducts and the majority of third-order ducts. 'Good' inter-reader agreement on Gd-EOB-DTPA-enhanced MRI and 'fair' inter-reader agreement on MRCP was noted for the left third-order medial duct. There was significantly better visualization of the cystic duct, left hepatic duct, and right second-order ducts on Gd-EOB-DTPA-enhanced MRI compared with MRCP. A 12.6% improvement in classifying the biliary branch pattern was also observed on Gd-EOB-DTPA-enhanced MRI compared with MRCP (P = 0.03). CONCLUSION Gd-EOB-DTPA-enhanced MRI provides additional diagnostic confidence over MRCP in the evaluation of the biliary ductal anatomy in potential LLDs.
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Kiss M, Deshpande RR, Nemeskéri Á, Nguyen TT, Kürti Z, Kovács S, Pápai Z, Németh K, Szuák A, Dudás I, Kóbori L. Optimal line of hepatotomy for left lateral living donor liver transplantation according to the anatomical variations of left hepatic duct system. Pediatr Transplant 2015; 19:510-6. [PMID: 25907302 DOI: 10.1111/petr.12468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2015] [Indexed: 12/13/2022]
Abstract
Multiple duct anastomoses during LLS transplantation increase the incidence of biliary complications. The optimal plane of hepatotomy that results in the least number of bile ducts at the surface was investigated according to LHD variations. Ducts of 30 human livers were injected with resin and LHD branching on 3D-CT reconstructions were analyzed. Ducts on the virtual hepatotomy surface were estimated in three splitting lines. Variations with subtypes were described. Ia (66.7%): ducts from segments (S.) II-III form a common trunk and S.IV duct joins it. Ib (10%): common trunk formed by ducts from S.II-S.III while S.IV duct joins the common hepatic duct. IIa (16.67%): S.IV duct drains into S.III duct. IIc (3.33%): S.IV duct drains into both S.II and S.III ducts. III (3.33%): trifurcation of S.II, S.III and S.IV ducts. When the virtual hepatotomy line was on the FL, there was a single duct for the anastomosis in 30% of cases but two, three, or four ducts in 53.3%, 10%, and 3.3%, respectively. Division 1 cm to the right of the FL resulted in one duct (70%), but S.IV duct injury may occur. LLS hepatotomy should not necessarily be performed along the FL. Variations must be taken into consideration to minimize the number of biliary anastomoses during liver implantation.
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Affiliation(s)
- Mátyás Kiss
- Department of Human Morphology and Developmental Biology, Semmelweis University Budapest, Budapest, Hungary
| | - Rahul R Deshpande
- Department of Hepatobiliary Surgery, Manchester Royal Infirmary, Manchester, UK
| | - Ágnes Nemeskéri
- Department of Human Morphology and Developmental Biology, Semmelweis University Budapest, Budapest, Hungary
| | - Tien T Nguyen
- Department of Human Morphology and Developmental Biology, Semmelweis University Budapest, Budapest, Hungary
| | - Zsuzsanna Kürti
- Department of Human Morphology and Developmental Biology, Semmelweis University Budapest, Budapest, Hungary
| | - Sándor Kovács
- Department of Human Morphology and Developmental Biology, Semmelweis University Budapest, Budapest, Hungary
| | - Zsolt Pápai
- Department of Human Morphology and Developmental Biology, Semmelweis University Budapest, Budapest, Hungary
| | - Károly Németh
- Department of Human Morphology and Developmental Biology, Semmelweis University Budapest, Budapest, Hungary
| | - András Szuák
- Department of Human Morphology and Developmental Biology, Semmelweis University Budapest, Budapest, Hungary
| | - Ibolyka Dudás
- Department of Radiology and Oncotherapy, Semmelweis University Budapest, Budapest, Hungary
| | - László Kóbori
- Department of Transplantation and Surgery, Semmelweis University Budapest, Budapest, Hungary
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Jeng KS, Huang CC, Lin CK, Lin CC, Chen KH, Chu SH. Repeated introperative cholangiography is helpful for donor safety in the procurement of right liver graft with supraportal right bile duct variants in living-donor liver transplantation. Transplant Proc 2015; 46:686-8. [PMID: 24767324 DOI: 10.1016/j.transproceed.2013.11.093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 11/15/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite recent advances in preoperative diagnostic imaging and operative techniques, biliary variation of the donor still remains a challenge in the procurement of graft. The supraportal right bile duct (BD) variant including presentation as trifurcation is a potential trap for injuring the remnant bile duct of donor. METHODS Before living/related-donor liver transplantation (LRLT), cholangiogram with magnetic resonance images of each donor was performed as a routine. After exploration of the donor before hilar dissection, intraoperative chloangiography (IOC) was routinely performed. Among the supraportal right bile duct variants, if the preoperative cholangiography showed a suspected trifurcation of the bile duct, we then performed 3 sessions of IOC during liver graft procurement, including prior to hilar dissection, before the division of bile ducts and after the division. We reviewed the cholangiogram and the postoperative laboratory data of a consecutive series of 25 donors of LRLT. RESULTS There was no division injury of the remnant bile duct of all of the donors. CONCLUSIONS Repeated IOC is suggested as a routine for variants of supraportal right bile ducts especially trifurcation pattern in graft procurement to avoid the injury of donor remnant bile ducts.
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Affiliation(s)
- K-S Jeng
- Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan.
| | - C-C Huang
- Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - C-K Lin
- Division of Gastroenterology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - C-C Lin
- Division of Gastroenterology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - K-H Chen
- Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - S-H Chu
- Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
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Abstract
Acute liver failure occurs abruptly with rapid progression. Traditional medical treatment and simple non-bioartificial liver support system cannot reverse the prognosis of acute liver failure (ALF), and liver transplantation is the only effective treatment. However, donor liver shortage, the need of a life-long immunosuppressive therapy as well as complex postoperative complications make ALF patients facing a variety of challenges in the perioperative period of liver transplantation, which are directly related to the success rate of surgery and the mortality. This article aims to discuss perioperative difficulties and preventive measures in liver transplantation for ALF by exploring how to extend the lives of patients before liver transplantation and how to deal with postoperative complications.
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Guler N, Dayangac M, Yaprak O, Akyildiz M, Gunay Y, Taskesen F, Tabandeh B, Bulutcu F, Yuzer Y, Tokat Y. Anatomical variations of donor portal vein in right lobe living donor liver transplantation: the safe use of variant portal veins. Transpl Int 2013; 26:1191-7. [DOI: 10.1111/tri.12190] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 06/10/2013] [Accepted: 08/30/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Necdet Guler
- Center for Organ Transplantation; Florence Nightingale Hospital; Istanbul Turkey
| | - Murat Dayangac
- Center for Organ Transplantation; Florence Nightingale Hospital; Istanbul Turkey
| | - Onur Yaprak
- Center for Organ Transplantation; Florence Nightingale Hospital; Istanbul Turkey
| | - Murat Akyildiz
- Center for Organ Transplantation; Florence Nightingale Hospital; Istanbul Turkey
- Department of Gastroenterology; Istanbul Bilim University; Istanbul Turkey
| | - Yusuf Gunay
- Center for Organ Transplantation; Florence Nightingale Hospital; Istanbul Turkey
| | - Fatih Taskesen
- Center for Organ Transplantation; Florence Nightingale Hospital; Istanbul Turkey
| | - Babek Tabandeh
- Department of General Surgery; Medical Park Goztepe Hospital; Istanbul Turkey
| | - Fisun Bulutcu
- Center for Organ Transplantation; Florence Nightingale Hospital; Istanbul Turkey
- Department of Anesthesiology; Istanbul Bilim University; Istanbul Turkey
| | - Yildiray Yuzer
- Center for Organ Transplantation; Florence Nightingale Hospital; Istanbul Turkey
| | - Yaman Tokat
- Center for Organ Transplantation; Florence Nightingale Hospital; Istanbul Turkey
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