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Nacif LS, Galvão F, Kubrusly MS, Zanini LYK, Espinoza P, Waisberg DR, Pinheiro RSN, da Silva AB, Rocha-Santos V, Alves VAF, Carneiro-D’Albuquerque L, Andraus W. Nuclear factor kappa-light-chain-enhancer of activated B cells gene expression involvement in porcine liver transplant experimental model. Acta Cir Bras 2024; 39:e392724. [PMID: 38958304 PMCID: PMC11216529 DOI: 10.1590/acb392724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/02/2024] [Indexed: 07/04/2024] Open
Abstract
PURPOSE Gene expressions of vascular Endothelial Growth Factor Alpha (VEGFa), Nuclear Factor Kappa-Light-Chain-Enhancer of Activated B cells (NFkB) and cytokines could be useful for identifying potential therapeutic targets to alleviate ischemia-reperfusion injury after liver transplantation. Cytokine gene expressions, VEGFa and NFkB were investigated in a preclinical swine model of liver transplantation. METHODS A total of 12 pigs were used as donors and recipients in liver transplantation without venovenous bypass or aortic clamping. NFkB, IL-6, IL-10, VEGFa and Notch1 gene expression were assessed. These samples were collected in two specific times: group 1 (n= 6) - control, samples were collected before recipient's total hepatectomy and group 2 - liver transplantation group (n=6), where the samples were collected one hour after graft reperfusion. RESULTS Liver transplantation was successfully performed in all recipients. Liver enzymes were elevated in the transplantation group. NFkB gene expression was significantly decreased in the transplantation group in comparison with the control group (0.62±0.19 versus 0.39±0.08; p= 0.016). No difference was observed between groups Interleucine 6 (IL-6), interleucine 10 (IL-10), VEGFa and Notch homolog 1 (Notch1). CONCLUSIONS In this survey a decreased NFkB gene expression in a porcine model of liver transplantation was observed.
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Affiliation(s)
- Lucas Souto Nacif
- Universidade de São Paulo – School of Medicine – Liver and Gastrointestinal Transplant Division – São Paulo (SP), Brazil
| | - Flávio Galvão
- Universidade de São Paulo – School of Medicine – Liver and Gastrointestinal Transplant Division – São Paulo (SP), Brazil
| | - Márcia Saldanha Kubrusly
- Universidade de São Paulo – School of Medicine – Liver and Gastrointestinal Transplant Division – São Paulo (SP), Brazil
| | - Leonardo Yuri Kasputis Zanini
- Universidade de São Paulo – School of Medicine – Liver and Gastrointestinal Transplant Division – São Paulo (SP), Brazil
| | - Paola Espinoza
- Universidade de São Paulo – School of Medicine – Liver and Gastrointestinal Transplant Division – São Paulo (SP), Brazil
| | - Daniel Reis Waisberg
- Universidade de São Paulo – School of Medicine – Liver and Gastrointestinal Transplant Division – São Paulo (SP), Brazil
| | - Rafael Soares Nunes Pinheiro
- Universidade de São Paulo – School of Medicine – Liver and Gastrointestinal Transplant Division – São Paulo (SP), Brazil
| | - Amadeo Batista da Silva
- Universidade de São Paulo – School of Medicine – Liver and Gastrointestinal Transplant Division – São Paulo (SP), Brazil
| | - Vinicius Rocha-Santos
- Universidade de São Paulo – School of Medicine – Liver and Gastrointestinal Transplant Division – São Paulo (SP), Brazil
| | | | - Luiz Carneiro-D’Albuquerque
- Universidade de São Paulo – School of Medicine – Liver and Gastrointestinal Transplant Division – São Paulo (SP), Brazil
| | - Wellington Andraus
- Universidade de São Paulo – School of Medicine – Liver and Gastrointestinal Transplant Division – São Paulo (SP), Brazil
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Kakos CD, Papanikolaou A, Ziogas IA, Tsoulfas G. Global dissemination of minimally invasive living donor hepatectomy: What are the barriers? World J Gastrointest Surg 2023; 15:776-787. [PMID: 37342850 PMCID: PMC10277954 DOI: 10.4240/wjgs.v15.i5.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/16/2023] [Accepted: 03/16/2023] [Indexed: 05/26/2023] Open
Abstract
Minimally invasive donor hepatectomy (MIDH) is a relatively novel procedure that can potentially increase donor safety and contribute to faster rehabilitation of donors. After an initial period in which donor safety was not effectively validated, MIDH currently seems to provide improved results, provided that it is conducted by experienced surgeons. Appropriate selection criteria are crucial to achieve better outcomes in terms of complications, blood loss, operative time, and hospital stay. Beyond a pure laparoscopic technique, various approaches have been recommended such as hand-assisted, laparoscopic-assisted, and robotic donation. The latter has shown equal outcomes compared to open and laparoscopic approaches. A steep learning curve seems to exist in MIDH, mainly due to the fragility of the liver parenchyma and the experience needed for adequate control of bleeding. This review investigated the challenges and the opportunities of MIDH and the barriers to its global dissemination. Surgeons need expertise in liver transplantation, hepatobiliary surgery, and minimally invasive techniques to perform MIDH. Barriers can be categorized into surgeon-related, institutional-related, and accessibility. More robust data and the creation of international registries are needed for further evaluation of the technique and the acceptance from more centers worldwide.
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Affiliation(s)
- Christos Dimitrios Kakos
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Transplant Surgery, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54622, Greece
| | - Angelos Papanikolaou
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Ioannis A Ziogas
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Georgios Tsoulfas
- Department of Transplant Surgery, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54622, Greece
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3
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Ghanaati H, Abrishami A, Hashem Zadeh A, Ghiasi M, Nasiri Toosi M, Jafarian A. Computed Tomography Fluoroscopy-Guided Percutaneous Transhepatic Bleomycin/Ethiodized Oil Sclerotherapy for Symptomatic Giant Hepatic Hemangioma. J Vasc Interv Radiol 2022; 33:1342-1348.e1. [PMID: 35863634 DOI: 10.1016/j.jvir.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 05/24/2022] [Accepted: 07/09/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To determine the safety and efficacy of computed tomography (CT) fluoroscopy-guided percutaneous transhepatic sclerotherapy with a bleomycin/ethiodized oil emulsion for symptomatic giant hepatic hemangiomas. MATERIALS AND METHODS The procedure was performed on 22 patients with symptomatic giant hepatic hemangiomas in an outpatient setting between 2018 and 2020. All patients were followed clinically and underwent contrast-enhanced magnetic resonance imaging after 1 month and again at a mean time of 15 months ± 2. Adverse events were classified according to the Common Terminology Criteria for Adverse Events (CTCAE, v5.0), in which a severe adverse event was defined as an adverse event with a grade of ≥3. The desired radiologic response (volume and index size) and improvement of pain intensity (visual analog scale [VAS]) and other symptoms were recorded as outcomes. RESULTS Overall, patients showed a 36.4% ± 8.6 reduction in volume and a 14% ± 1.6 reduction in index size after 1 month, with P values of .002 and .001, respectively. The final follow-up volume and index size were 194.7 cm3 ± 25.8 and 77 mm ± 36, respectively. Moreover, a 53.0% ± 7 reduction in volume and 22% ± 3.7 reduction in index size during the final imaging were reported, with the P values of .001 and .001, respectively. Significant reductions in the mean pain intensity (90% of patients with lower VAS scores after intervention) and symptoms were reported. Four patients were classified as clinically unsuccessful, and were recommended further procedures for residual pain. CONCLUSIONS CT fluoroscopy-guided transhepatic sclerotherapy is an effective, safe, and minimally invasive method to manage giant hepatic hemangiomas in an outpatient setting.
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Affiliation(s)
- Hossein Ghanaati
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center, Medical Imaging Center, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Alireza Abrishami
- Department of Radiology, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Arezou Hashem Zadeh
- Student's Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Ghiasi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohssen Nasiri Toosi
- Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Jafarian
- Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Imam Khomeini Hospital Complex, Tehran University of Medical Science, Tehran, Iran
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4
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Truant S, Baillet C, Fulbert M, Olivier A, Sergent G, Turpin A, Boleslawski E, El Amrani M, Huglo D, Pruvot FR. Asymmetric kinetics of volume and function of the remnant liver after major hepatectomy as a key for postoperative outcome - A case-matched study. HPB (Oxford) 2020; 22:855-863. [PMID: 31669198 DOI: 10.1016/j.hpb.2019.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/22/2019] [Accepted: 10/01/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The kinetics of remnant liver (RL) function is unknown after major hepatectomy (MH), especially in case of post-hepatectomy liver failure (PHLF). This study investigated the change in RL function after MH using 99mTc-labelled-mebrofenin SPECT-scintigraphy and its correlation with RL volume and PHLF. METHODS From 2011 to 2015, 125 patients undergoing MH had volumetric assessment by CT and functional SPECT-scintigraphy preoperatively and at day 7 (POD7) and 1 month (1M). RL volume and function changes were compared in (i) overall population and (ii) 17 patients with vs. 42 without PHLF (ISGLS) matched on preoperative RL function. RESULTS Increase in RL function correlated poorly with volume increase at POD7 (r = 0.035, p = 0.43) and 1M (r = 0.394, p < 0.0001). Overall, function increase on POD7 (+38.8%) was lower than volume (+49.4%), but comparable at 1M (+78.8% vs. +73%). PHLF patients showed lower function increase on POD7 (+2.1% [-89%-77.8%] vs. +50% [-39%-218%]; p = 0.006). At 1M, 4 PHLF patients died with no function increase despite significant volumetric gain. CONCLUSIONS We first showed via sequential SPECT-scintigraphy that RL function increase after MH is slower than volume increase. A poor kinetic of function was correlated with PHLF as early as POD7, contrasting with substantial volume gain in PHLF patients.
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Affiliation(s)
- Stéphanie Truant
- Department of Digestive Surgery and Transplantation, CHU, Univ Nord de France, F-59000 Lille, France.
| | - Clio Baillet
- Department of Nuclear Medicine, CHU, Univ Nord de France, F-59000 Lille, France
| | - Maxence Fulbert
- Department of Digestive Surgery and Transplantation, CHU, Univ Nord de France, F-59000 Lille, France
| | - Anais Olivier
- Department of Nuclear Medicine, CHU, Univ Nord de France, F-59000 Lille, France
| | - Géraldine Sergent
- Department of Radiology, CHU, Univ Nord de France, F-59000 Lille, France
| | - Anthony Turpin
- Department of Medical Oncology, CHU, Univ Nord de France, F-59000 Lille, France
| | - Emmanuel Boleslawski
- Department of Digestive Surgery and Transplantation, CHU, Univ Nord de France, F-59000 Lille, France
| | - Mehdi El Amrani
- Department of Digestive Surgery and Transplantation, CHU, Univ Nord de France, F-59000 Lille, France
| | - Damien Huglo
- Department of Nuclear Medicine, CHU, Univ Nord de France, F-59000 Lille, France
| | - François-René Pruvot
- Department of Digestive Surgery and Transplantation, CHU, Univ Nord de France, F-59000 Lille, France
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Somatostatin and the "Small-For-Size" Liver. Int J Mol Sci 2019; 20:ijms20102512. [PMID: 31121844 PMCID: PMC6566601 DOI: 10.3390/ijms20102512] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/07/2019] [Accepted: 05/14/2019] [Indexed: 02/07/2023] Open
Abstract
“Small-for-size” livers arising in the context of liver resection and transplantation are vulnerable to the effects of increased portal flow in the immediate postoperative period. Increased portal flow is an essential stimulus for liver regeneration. If the rise in flow and stimulus for regeneration are excessive; however, liver failure and patient death may result. Somatostatin is an endogenous peptide hormone that may be administered exogenously to not only reduce portal blood flow but also offer direct protection to different cells in the liver. In this review article, we describe key changes that transpire in the liver following a relative size reduction occurring in the context of resection and transplantation and the largely beneficial effects that peri-operative somatostatin therapy may help achieve in this setting.
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6
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Ray S, Mehta N, Golhar A, Nundy S. Post hepatectomy liver failure - A comprehensive review of current concepts and controversies. Ann Med Surg (Lond) 2018; 34:4-10. [PMID: 30181871 PMCID: PMC6120608 DOI: 10.1016/j.amsu.2018.08.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/24/2018] [Accepted: 08/14/2018] [Indexed: 02/06/2023] Open
Abstract
Post hepatectomy liver failure (PHLF) comprises of a conundrum of symptoms and signs following major hepatic resections. The pathophysiology essentially revolves around disruption of the normal hepatocyte regeneration and disturbed liver homeostasis. Prompt identification of the pre-operative predictors of PHLF in the form of biochemical parameters and imaging features are of paramount importance for any hepatic surgeon and forms the cornerstone of its management. Treatment revolves around a goal-directed resuscitation of the systemic organ failure. Auxiliary support systems such as liver dialysis devices and stem cell therapy are still under investigational trials for treatment of the same. Orthotopic liver transplantation (OLT) is the last resort in most cases not responding to other measures.
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Affiliation(s)
- S. Ray
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
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7
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Duclos J, Bhangui P, Salloum C, Andreani P, Saliba F, Ichai P, Elmaleh A, Castaing D, Azoulay D. Ad Integrum Functional and Volumetric Recovery in Right Lobe Living Donors: Is It Really Complete 1 Year After Donor Hepatectomy? Am J Transplant 2016; 16:143-56. [PMID: 26280997 DOI: 10.1111/ajt.13420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 05/27/2015] [Accepted: 06/11/2015] [Indexed: 02/07/2023]
Abstract
The partial liver's ability to regenerate both as a graft and remnant justifies right lobe (RL) living donor liver transplantation. We studied (using biochemical and radiological parameters) the rate, extent of, and predictors of functional and volumetric recovery of the remnant left liver (RLL) during the first year in 91 consecutive RL donors. Recovery of normal liver function (prothrombin time [PT] ≥70% of normal and total bilirubin [TB] ≤20 µmol/L), liver volumetric recovery, and percentage RLL growth were analyzed. Normal liver function was regained by postoperative day's 7, 30, and 365 in 52%, 86%, and 96% donors, respectively. Similarly, mean liver volumetric recovery was 64%, 71%, and 85%; whereas the percentage liver growth was 85%, 105%, and 146%, respectively. Preoperative PT value (p = 0.01), RLL/total liver volume (TLV) ratio (p = 0.03), middle hepatic vein harvesting (p = 0.02), and postoperative peak TB (p < 0.01) were predictors of early functional recovery, whereas donor age (p = 0.03), RLL/TLV ratio (p = 0.004), and TLV/ body weight ratio (p = 0.02) predicted early volumetric recuperation. One-year post-RL donor hepatectomy, though functional recovery occurs in almost all (96%), donors had incomplete restoration (85%) of preoperative total liver volume. Modifiable predictors of regeneration could help in better and safer donor selection, while continuing to ensure successful recipient outcomes.
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Affiliation(s)
- J Duclos
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - P Bhangui
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - C Salloum
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - P Andreani
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - F Saliba
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - P Ichai
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - A Elmaleh
- Service de Radiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - D Castaing
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - D Azoulay
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France.,Unité INSERM 1004, Villejuif, France
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8
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Risk Factors Associated with Increased Morbidity in Living Liver Donation. J Transplant 2015; 2015:949674. [PMID: 26788361 PMCID: PMC4693020 DOI: 10.1155/2015/949674] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/19/2015] [Accepted: 11/24/2015] [Indexed: 02/07/2023] Open
Abstract
Living donor liver donation (LDLD) is an alternative to cadaveric liver donation. We aimed at identifying risk factors and developing a score for prediction of postoperative complications (POCs) after LDLD in donors. This is a retrospective cohort study in 688 donors between June 1995 and February 2014 at Hospital Sírio-Libanês and A.C. Camargo Cancer Center, in São Paulo, Brazil. Primary outcome was POC graded ≥III according to the Clavien-Dindo classification. Left lateral segment (LLS), left lobe (LL), and right lobe resections (RL) were conducted in 492 (71.4%), 109 (15.8%), and 87 (12.6%) donors, respectively. In total, 43 (6.2%) developed POCs, which were more common after RL than LLS and LL (14/87 (16.1%) versus 23/492 (4.5%) and 6/109 (5.5%), resp., p < 0.001). Multivariate analysis showed that RL resection (OR: 2.81, 95% CI: 1.32 to 3.01; p = 0.008), smoking status (OR: 3.2, 95% CI: 1.35 to 7.56; p = 0.012), and blood transfusion (OR: 3.15, 95% CI: 1.45 to 6.84; p = 0.004) were independently associated with POCs. RL resection, intraoperative blood transfusion, and smoking were associated with increased risk for POCs in donors.
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9
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Meier RPH, Toso C, Terraz S, Breguet R, Berney T, Andres A, Jannot AS, Rubbia-Brandt L, Morel P, Majno PE. Improved liver function after portal vein embolization and an elective right hepatectomy. HPB (Oxford) 2015; 17:1009-18. [PMID: 26345460 PMCID: PMC4605340 DOI: 10.1111/hpb.12501] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/16/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Portal vein embolization (PVE) is used before extensive hepatic resections to increase the volume of the future remnant liver within acceptable safety margins (conventionally >0.6% of the patient's weight). The objective was to determine whether pre-operative PVE impacts on post-operative liver function independently from the increase in liver volume. METHODS The post-operative liver function of patients who underwent an anatomical right liver resection with (n = 28) and without (n = 53) PVE were retrospectively analysed. Donors of the right liver were also analysed (LD) (n = 17). RESULTS Patient characteristics were similar, except for age, weight and American Society of Anesthesiologists (ASA) score that were lower in LD. Post-operative factor V and bilirubin levels were, respectively, higher and lower in patients with PVE compared with patients without PVE or LD (P < 0.05). Patients with PVE had an increased blood loss, blood transfusions and sinusoidal obstruction syndrome. The day-3 bilirubin level was 40% lower in the PVE group compared with the no-PVE group after adjustment for body weight, chemotherapy, operating time, Pringle time, blood transfusions, remnant liver volume, pre-operative bilirubin level and pre-operative prothrombin ratio (P = 0.001). CONCLUSIONS For equivalent volumes, the immediate post-operative hepatic function appears to be better in livers prepared with PVE than in unprepared livers. Future studies should analyse whether the conventional inferior volume limit that allows a safe liver resection may be lowered when a PVE is performed.
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Affiliation(s)
- Raphael P H Meier
- Hepato-Pancreato-Biliary Centre, Visceral and Transplantation Surgery, Department of Surgery, University Hospitals of Geneva and Faculty of MedicineGeneva, Switzerland
| | - Christian Toso
- Hepato-Pancreato-Biliary Centre, Visceral and Transplantation Surgery, Department of Surgery, University Hospitals of Geneva and Faculty of MedicineGeneva, Switzerland
| | - Sylvain Terraz
- Department of Radiology, University Hospitals of Geneva and Faculty of MedicineGeneva, Switzerland
| | - Romain Breguet
- Department of Radiology, University Hospitals of Geneva and Faculty of MedicineGeneva, Switzerland
| | - Thierry Berney
- Hepato-Pancreato-Biliary Centre, Visceral and Transplantation Surgery, Department of Surgery, University Hospitals of Geneva and Faculty of MedicineGeneva, Switzerland
| | - Axel Andres
- Hepato-Pancreato-Biliary Centre, Visceral and Transplantation Surgery, Department of Surgery, University Hospitals of Geneva and Faculty of MedicineGeneva, Switzerland
| | - Anne-Sophie Jannot
- Division of Clinical Epidemiology and Clinical Research Centre, University Hospitals of Geneva and Faculty of MedicineGeneva, Switzerland
| | - Laura Rubbia-Brandt
- Division of Clinical Pathology, University Hospitals of Geneva and Faculty of MedicineGeneva, Switzerland
| | - Philippe Morel
- Hepato-Pancreato-Biliary Centre, Visceral and Transplantation Surgery, Department of Surgery, University Hospitals of Geneva and Faculty of MedicineGeneva, Switzerland
| | - Pietro E Majno
- Hepato-Pancreato-Biliary Centre, Visceral and Transplantation Surgery, Department of Surgery, University Hospitals of Geneva and Faculty of MedicineGeneva, Switzerland
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10
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Radtke A, Sgourakis G, Molmenti EP, Beckebaum S, Cicinnati VR, Schmidt H, Peitgen HO, Broelsch CE, Malagó M, Schroeder T. Risk of venous congestion in live donors of extended right liver graft. World J Gastroenterol 2015; 21:6008-6017. [PMID: 26019467 PMCID: PMC4438037 DOI: 10.3748/wjg.v21.i19.6008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 02/01/2015] [Accepted: 04/03/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate middle hepatic vein (MHV) management in adult living donor liver transplantation and safer remnant volumes (RV).
METHODS: There were 59 grafts with and 12 grafts without MHV (including 4 with MHV-5/8 reconstructions). All donors underwent our five-step protocol evaluation containing a preoperative protocol liver biopsy Congestive vs non-congestive RV, remnant-volume-body-weight ratios (RVBWR) and postoperative outcomes were evaluated in 71 right graft living donors. Dominant vs non-dominant MHV anatomy in total liver volume (d-MHV/TLV vs nd-MHV/TLV) was constellated with large/small congestion volumes (CV-index). Small for size (SFS) and non-SFS remnant considerations were based on standard cut-off- RVBWR and RV/TLV. Non-congestive RVBWR was based on non-congestive RV.
RESULTS: MHV and non-MHV remnants showed no significant differences in RV, RV/TLV, RVBWR, total bilirubin, or INR. SFS-remnants with RV/TLV < 30% and non-SFS-remnants with RV/TLV ≥ 30% showed no significant differences either. RV and RVBWR for non-MHV (n = 59) and MHV-containing (n = 12) remnants were 550 ± 95 mL and 0.79 ± 0.1 mL vs 568 ± 97 mL and 0.79 ± 0.13, respectively (P = 0.423 and P = 0.919. Mean left RV/TLV was 35.8% ± 3.9%. Non-MHV (n = 59) and MHV-containing (n = 12) remnants (34.1% ± 3% vs 36% ± 4% respectively, P = 0.148. Eight SFS-remnants with RVBWR < 0.65 had a significantly smaller RV/TLV than 63 non-SFS-remnants with RVBWR ≥ 0.65 [SFS: RV/TLV 32.4% (range: 28%-35.7%) vs non-SFS: RV/TLV 36.2% (range: 26.1%-45.5%), P < 0.009. Six SFS-remnants with RV/TLV < 30% had significantly smaller RVBWR than 65 non-SFS-remnants with RV/TLV ≥ 30% (0.65 (range: 0.6-0.7) vs 0.8 (range: 0.6-1.27), P < 0.01. Two (2.8%) donors developed reversible liver failure. RVBWR and RV/TLV were concordant in 25%-33% of SFS and in 92%-94% of non-SFS remnants. MHV management options including complete MHV vs MHV-4A selective retention were necessary in n = 12 vs n = 2 remnants based on particularly risky congestive and non-congestive volume constellations.
CONCLUSION: MHV procurement should consider individual remnant congestive- and non-congestive volume components and anatomy characteristics, RVBWR-RV/TLV constellation enables the identification of marginally small remnants.
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11
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Hypertrophy of the Left Liver in Patients with Large Tumors in the Right Liver. World J Surg 2015; 39:2031-6. [PMID: 25813823 DOI: 10.1007/s00268-015-3033-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND It has been speculated that, when right-sided major hepatectomy (RSMH) is planned for patients with large tumors in the right liver, it may not lead to a marked decrease in normally functional hepatic mass. METHODS We collected data for patients who had undergone RSMH for tumors more than 8 cm in diameter (n=50) and compared them with control patients who had undergone RSMH for tumors less than 5 cm in diameter (n=21). RESULTS The ratio of the remnant left liver volume to the nontumorous liver volume (left liver ratio) in the patients with large tumors was significantly greater than that in the control group (50.0±12.8% vs. 40.2±8.3%, p=0.002). Left liver ratio was significantly correlated with tumor volume (p<0.001). Preoperative portal vein embolization was performed in only four of the 50 patients with large tumors. None of the patients with large tumors developed postoperative liver failure. CONCLUSIONS Left liver volume in patients with large tumors in the right liver was larger than usual, perhaps reducing the risk of postoperative liver insufficiency after RSMH.
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12
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Cauchy F, Schwarz L, Scatton O, Soubrane O. Laparoscopic liver resection for living donation: Where do we stand? World J Gastroenterol 2014; 20:15590-15598. [PMID: 25400442 PMCID: PMC4229523 DOI: 10.3748/wjg.v20.i42.15590] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/21/2014] [Accepted: 09/05/2014] [Indexed: 02/07/2023] Open
Abstract
In Western countries, living donor liver transplantation (LDLT) may represent a valuable alternative to deceased donor liver transplantation. Yet, after an initial peak of enthusiasm, reports of high rates of complications and of fatalities have led to a certain degree of reluctance towards this procedure especially in Western countries. As for living donor kidney transplantation, the laparoscopic approach could improve patient’s tolerance in order to rehabilitate this strategy and reverse the current trend. In this setting however, initial concerns regarding patient’s safety and graft integrity, need for acquiring surgical expertise in both laparoscopic liver surgery and living donor transplantation and lack of evidence supporting the benefits of laparoscopy have delayed the development of this approach. Similarly to what is performed in classical resectional liver surgery, initial experiences of laparoscopy have therefore begun with left lateral sectionectomy, which is performed for adult to child living donation. In this setting, the laparoscopic technique is now well standardized, is associated with decreased donor blood loss and hospital stays and provides graft of similar quality compared to the open approach. On the other hand laparoscopic major right or left hepatectomies for adult-adult LDLT currently lack standardization and various techniques such as the full laparoscopic approach, the hand assisted approach and the hybrid approach have been reported. Hence, even-though several reports highlight the feasibility of these procedures, the true benefits of laparoscopy over laparotomy remain to be fully assessed. This could be achieved through standardization of the procedures and creation of international registries especially in Eastern countries where LDLT keeps on flourishing.
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Hessheimer AJ, Escobar B, Muñoz J, Flores E, Gracia-Sancho J, Taurá P, Fuster J, Rimola A, García-Valdecasas JC, Fondevila C. Somatostatin therapy protects porcine livers in small-for-size liver transplantation. Am J Transplant 2014; 14:1806-16. [PMID: 24935350 DOI: 10.1111/ajt.12758] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/17/2014] [Accepted: 03/25/2014] [Indexed: 01/25/2023]
Abstract
Small-for-size (SFS) injury occurs in partial liver transplantation due to several factors, including excessive portal inflow and insufficient intragraft responses. We aim to determine the role somatostatin plays in reducing portal hyperperfusion and preventing the cascade of deleterious events produced in small grafts. A porcine model of 20% liver transplantation is performed. Perioperatively treated recipients receive somatostatin and untreated controls standard intravenous fluids. Recipients are followed for up to 5 days. In vitro studies are also performed to determine direct protective effects of somatostatin on hepatic stellate cells (HSC) and sinusoidal endothelial cells (SEC). At reperfusion, portal vein flow (PVF) per gram of tissue increased fourfold in untreated animals versus approximately threefold among treated recipients (p = 0.033). Postoperatively, markers of hepatocellular, SEC and HSC injury were improved among treated animals. Hepatic regeneration occurred in a slower but more orderly fashion among treated grafts; functional recovery was also significantly better. In vitro studies revealed that somatostatin directly reduces HSC activation, though no direct effect on SEC was found. In SFS transplantation, somatostatin reduces PVF and protects SEC in the critical postreperfusion period. Somatostatin also exerts a direct cytoprotective effect on HSC, independent of changes in PVF.
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Affiliation(s)
- A J Hessheimer
- Department of Surgery, Institut de Malalties Digestives I Metabòliques (IMDiM), Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
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Gregoire E, Brige P, Barbier L, Buffat C, Coppola A, Hardwigsen J, Le Treut YP, Vidal V, Rolland PH. Minimal portal vein stenosis is a promising preconditioning in living donor liver transplantation in porcine model. J Hepatol 2014; 61:59-66. [PMID: 24662302 DOI: 10.1016/j.jhep.2014.02.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 02/10/2014] [Accepted: 02/22/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND & AIMS The main hindrance in promoting living donor liver transplantation remains the morbi-mortality risk for the donor. Considering the opposed remodeling influence of portal and hepatic artery flows, our working hypothesis was to identify a lobar portal vein stenosis capable of inducing a contralateral liver mass compensatory enlargement, without the downstream ipsilateral atrophic response. METHODS Twenty-four pigs entered this study. Six of them were used to establish hemodynamic changes following a progressive left portal vein (LPV) stenosis, in blood flow, pressure and vessel diameter of the LPV, main portal vein and hepatic artery. Sixteen pigs were divided into 4 groups: sham operated animals, 20% LPV stenosis, 50% LPV stenosis, and 100% LPV stenosis. Daily liver biopsies were collected until post-operative day 5 to investigate liver regeneration and atrophy (Ki67, STAT3, LC3, and activated caspase 3) according to the degree of LPV stenosis. Finally, changes in liver volumetry after 20% LPVS were investigated. RESULTS A 20% LPV stenosis led to dilatation of the hepatic artery and a subsequent four-fold increase in hepatic arterial flow. Concomitantly, liver regeneration was triggered in the non-ligated lobe and the cell proliferation peak, 5 days after surgery, was comparable to that obtained after total LPV ligation. Moreover, 20% LPV stenosis preconditioning did not induce left liver atrophy contrary to 50 and 100% LPV stenosis. CONCLUSIONS A 20% LPV stenosis seems to be the adequate preconditioning to get the remnant liver of living donor ready to take on graft harvesting without atrophy of the future graft.
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Affiliation(s)
- E Gregoire
- Aix-Marseille University, Department of General Surgery and Liver Transplantation, Hôpital de la Conception Marseille, France.
| | - P Brige
- Aix-Marseille University, Experimental Interventional Imaging Laboratory, European Center for Medical Imaging Research, Marseille, France
| | - L Barbier
- Aix-Marseille University, Department of General Surgery and Liver Transplantation, Hôpital de la Conception Marseille, France
| | - C Buffat
- Aix-Marseille University; URMITE, CNRS UMR 6236-IRD 198, Marseille, France; Laboratoire de Biochimie et de Biologie Moléculaire, Hôpital de la Conception Marseille, France
| | - A Coppola
- Aix-Marseille University, Experimental Interventional Imaging Laboratory, European Center for Medical Imaging Research, Marseille, France
| | - J Hardwigsen
- Aix-Marseille University, Department of General Surgery and Liver Transplantation, Hôpital de la Conception Marseille, France
| | - Y P Le Treut
- Aix-Marseille University, Department of General Surgery and Liver Transplantation, Hôpital de la Conception Marseille, France
| | - V Vidal
- Aix-Marseille University, Experimental Interventional Imaging Laboratory, European Center for Medical Imaging Research, Marseille, France
| | - P H Rolland
- Aix-Marseille University, Experimental Interventional Imaging Laboratory, European Center for Medical Imaging Research, Marseille, France
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Lee JG, Han DH, Choi SH, Choi GH, Choi JS. Surgical Outcomes and Complications after Right Hepatectomy in Living Donation for Adult Liver Transplantation: Single Center Experiences from 245 Cases. KOREAN JOURNAL OF TRANSPLANTATION 2014. [DOI: 10.4285/jkstn.2014.28.1.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jae Geun Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Dai Hoon Han
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hoon Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Gi Hong Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sub Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Durand F. Is it worth discussing the feasibility of deceased donor liver transplantation in centers with a strong experience in living donor liver transplantation? World J Surg 2014; 38:1529-30. [PMID: 24549998 DOI: 10.1007/s00268-014-2479-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- François Durand
- Service d'Hépatologie, Hepatology & Liver Intensive Care, Hospital Beaujon, University Paris VII, 100 Boulevard du General Leclerc, 92110, Clichy, France,
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Mihara K, Sugiura T, Okamura Y, Kanemoto H, Mizuno T, Moriguchi M, Aramaki T, Uesaka K. A predictive factor of insufficient liver regeneration after preoperative portal vein embolization. ACTA ACUST UNITED AC 2013; 51:118-28. [PMID: 24247292 DOI: 10.1159/000356368] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 10/14/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND Preoperative portal vein embolization (PVE) is performed to enhance the future remnant liver function (FRLF) and volume (FRLV). However, the volume of the nonembolized liver does not increase enough in some patients, which results in an insufficient FRLF. The aim of this study was to evaluate the predictors of insufficient FRLF after PVE for extended hepatectomy. METHODS This retrospective study included 172 patients (107 patients with cholangiocarcinoma, 40 patients with metastatic liver cancer and 25 patients with hepatocellular carcinoma) who underwent PVE before extended hepatectomy. The total liver function was evaluated by measuring the indocyanine green plasma clearance rate (KICG). Computed tomography volumetry was conducted to evaluate the total liver volume and FRLV. The KICG of the future remnant liver (remK) was calculated using the following formula: KICG × FRLV/total liver volume. The safety margin for hepatectomy was set at remK after PVE (post-PVE remK) ≥ 0.05. RESULTS One hundred and twenty-three patients with a post-PVE remK level of >0.05 underwent hepatectomy without postoperative liver failure [sufficient liver regeneration (SLR) group], and 9 patients with a post-PVE remK level of <0.05 did not due to insufficient FRLF [insufficient liver regeneration (ILR) group]. In the SLR group, the KICG values did not change after PVE (median, 0.144-0.146, p = 0.523); however, the %FRLV and remK increased significantly (35.0-44.3%, p < 0.001 and 0.0488-0.0610, p < 0001, respectively). In contrast, in the ILR group, the KICG values decreased significantly (0.128-0.108, p = 0.021) and the %FRLV increased marginally (27.4-32.6%, p = 0.051). As a result, the remK did not increase significantly (0.0351-0.0365, p = 0.213). A receiver operating characteristic curve demonstrated an remK value of 0.04 obtained before PVE (pre-PVE remK) to be the optimal cutoff point for defective liver regeneration. The univariate and multivariate analyses revealed that a pre-PVE remK value of <0.04 was a factor for ILR. It was also correlated with postoperative liver failure in the analysis of the patients who underwent hepatectomy. CONCLUSIONS The patients in the ILR group did not achieve SLR after PVE due to a significant decrease in the KICG and an insufficient increase in %FRLV. A pre-PVE remK value of <0.04 is a useful predictor of insufficient regeneration of the nonembolized liver, even after PVE.
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Affiliation(s)
- K Mihara
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
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Dokmak S, Elkrief L, Belghiti J. Auxiliary liver transplantation with a small deceased liver graft for cirrhotic liver complicated by hepatocellular carcinoma. Transpl Int 2013; 26:e102-4. [DOI: 10.1111/tri.12173] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Safi Dokmak
- Department of HPB surgery and liver transplantation; Beaujon Hopsital; Clichy; France
| | - Laure Elkrief
- Department of Hepatology; Beaujon Hopsital; Clichy; France
| | - Jacques Belghiti
- Department of HPB surgery and liver transplantation; Beaujon Hopsital; Clichy; France
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Current world literature. Curr Opin Organ Transplant 2013; 18:241-50. [PMID: 23486386 DOI: 10.1097/mot.0b013e32835f5709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Golse N, Bucur PO, Adam R, Castaing D, Sa Cunha A, Vibert E. New paradigms in post-hepatectomy liver failure. J Gastrointest Surg 2013; 17:593-605. [PMID: 23161285 DOI: 10.1007/s11605-012-2048-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 10/04/2012] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Liver failure after hepatectomy remains the most feared postoperative complication. Many risk factors are already known, related to patient's comorbidities, underlying liver disease, received treatments and type of resection. Preoperative assessment of functional liver reserve must be a priority for the surgeon. METHODS Physiopathology of post-hepatectomy liver failure is not comparable to fulminant liver failure. Liver regeneration is an early phenomenon whose cellular mechanisms are beginning to be elucidated and allowing most of the time to quickly recover a functional organ. In some cases, microscopic and macroscopic disorganization appears. The hepatocyte hyperproliferation and the asynchronism between hepatocytes and non-hepatocyte cells mitosis probably play a major role in this pathogenesis. RESULTS Many peri- or intra-operative techniques try to prevent the occurrence of this potentially lethal complication, but a better understanding of involved mechanisms might help to completely avoid it, or even to extend the possibilities of resection. CONCLUSION Future prevention and management may include pharmacological slowing of proliferation, drug or physical modulation of portal flow to reduce shear-stress, stem cells or immortalized hepatocytes injection, and liver bioreactors. Everything must be done to avoid the need for transplantation, which remains today the most efficient treatment of liver failure.
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Affiliation(s)
- Nicolas Golse
- Centre Hépatobiliaire, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Université Paris XI, Paris, France.
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Sánchez-Cabús S, Fondevila C, Calatayud D, Ferrer J, Taurá P, Fuster J, García-Valdecasas JC. Importance of the temporary portocaval shunt during adult living donor liver transplantation. Liver Transpl 2013; 19:174-83. [PMID: 23055401 DOI: 10.1002/lt.23558] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 09/28/2012] [Indexed: 02/07/2023]
Abstract
Adult living donor liver transplantation (aLDLT) is associated with surgical risks for the donor and with the possibility of small-for-size syndrome (SFSS) for the recipient, with both events being of great importance. An excessively small liver graft entails a relative increase in the portal blood flow during reperfusion, and this factor predisposes the recipient to an increased risk of SFSS in the postoperative period, although other causes related to recipient, graft, and technical factors have also been reported. A hemodynamic monitoring protocol was used for 45 consecutive aLDLT recipients. After various hemodynamic parameters before reperfusion were analyzed, a significant correlation between the temporary portocaval shunt flow during the anhepatic phase and the portal vein flow (PVF) after reperfusion of the graft (R(2) = 0.3, P < 0.001) was found, and so was a correlation between the native liver portal pressure and PVF after reperfusion (R(2) = 0.21, P = 0.007). The identification of patients at risk for excessive portal hyperflow will allow its modulation before reperfusion. This could favor the use of smaller grafts and ultimately lead to a reduction in donor complications because it would allow more limited hepatectomies to be performed.
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Affiliation(s)
- Santiago Sánchez-Cabús
- Hepatobiliary Surgery and Liver Transplantation Unit, Hospital Clinic of Barcelona, Barcelona, Spain
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Sadamori H, Yagi T, Shinoura S, Umeda Y, Yoshida R, Satoh D, Nobuoka D, Utsumi M, Yoshida K, Fujiwara T. Bloodless donor hepatectomy in living donor liver transplantation: counterclockwise liver rotation and early hanging maneuver. J Gastrointest Surg 2013; 17:203-6. [PMID: 22573114 DOI: 10.1007/s11605-012-1907-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 04/30/2012] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Living donor hepatectomy is important because it determines donor safety and recipient outcome. METHODS We applied the counter-clockwise liver rotation method and the hanging maneuver from an early stage in two major types of living donor operations. RESULT Twenty-eight living donors underwent these procedures with significant reduction in blood loss. Right hepatectomy was performed in 14 of the donors and extended left hepatectomy was performed in the other 14 donors. CONCLUSION These techniques facilitate safe and bloodless living donor hepatectomy.
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Affiliation(s)
- Hiroshi Sadamori
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama 700-8558, Japan.
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Radtke A, Sgourakis G, Molmenti EP, Schroeder T, Cicinnati VR, Beckebaum S, Peitgen HO, Broelsch CE, Malagó M. The "carving" liver partitioning technique for graft hepatectomy in live donor liver transplantation: a single-center experience. Surgery 2012; 153:189-99. [PMID: 22884089 DOI: 10.1016/j.surg.2012.06.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 06/14/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND In adult live donor liver transplantation, postoperative venous congestion of graft and remnant livers can lead to life-threatening complications. The purpose of this study was to evaluate the safety and benefits of our 3-dimensional, computed tomographic, computer-assisted donor hepatectomy using the "carving" partitioning technique. METHODS Eighty-three consecutive adult live donor liver transplantations were performed based on data obtained from individualized preoperative 3-dimensional, computed tomographic reconstructions and virtual graft hepatectomies. RESULTS There were 71 right and 12 left grafts. Small grafts (graft volume body weight ratio, <1.0) were used in 20 cases. We observed no clinically important differences in postoperative function between right and left grafts. Four recipients developed lethal small-for-size syndrome. Reversible small-for-size syndrome was observed in a right graft recipient and in 2 right graft donors. CONCLUSION Preoperative 3-dimensional, computed tomographic, computer-assisted planning using virtual liver partitioning allowed for: (1) an individualized carving technique based on specific donor anatomic characteristics, (2) donor safety based on individualized patterns of venous outflow, and (3) optimized drainage of the medial area of the graft based on the preferential inclusion of the middle hepatic vein.
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Affiliation(s)
- Arnold Radtke
- Department of General, Thoracic, and Transplant Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
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