Reliable monitoring enabling evaluation of graft function is crucial after living-donor liver transplantation (LDLT). A method to identify poor graft function at an early postoperative period would allow opportune intensive clinical management to bring about further improvements in LDLT outcomes. This study assessed the reliability of the indocyanine green (ICG) elimination rate constant (K ICG ) value as an estimator of graft function and determined the actual temporal changes of K ICG after LDLT. K ICG values were measured using a noninvasive method in 30 adult recipients up to 28 days after LDLT. The receptor index (LHL15) based on liver scintigraphy, and graft parenchymal damage score based on histopathological findings were evaluated after LDLT and correlated well with simultaneous K ICG . Thus, K ICG measured by noninvasive method was confirmed as accurately evaluating graft function. Changes of K ICG after LDLT in recipients with good graft function were maintained, after some falls in the early periods, and had a significant difference compared with those for recipients without good graft function; moreover, there were already significant differences in K ICG 24 hours after LDLT. Mean transit time reflecting systemic hemodynamics revealed that recipients without good outcomes fell into an unstable systemic hemodynamic state, and effective hepatic blood flow has a large influence on liver regeneration after LDLT. In conclusion, we suggested that K ICG values can predict clinical outcomes at the early postoperative period after LDLT by sharply reflecting the influence of systemic dynamics on splanchnic circulation. See Editorial on Page 514Liver allografts suffer several types of attacks, such as ischemia reperfusion injury and acute rejection, and they are exposed to risks, including hepatic blood flow disorders. Therefore, a precise estimation of graft function after living donor liver transplantation (LDLT) is extremely important; indeed, it is indispensable for appropriate postoperative treatments. However, conventional simple liver function tests, such as the aspartate aminotransferase (AST), alanine aminotransferase (ALT), and prothrombin time international normalized ratio (PT-INR), can assist in evaluating graft function but are not always conclusive. Though 81 LDLT (51 right-lobe, 21 left-lobe, and 9 lateral-segment grafts) to 73 adult and 8 pediatric recipients have been performed to date in our facilities, we have had concerns regarding the accurate evaluation of graft function. Since indocyanine green (ICG), a nontoxic dye, is extracted exclusively by hepatic parenchymal cells without enterohepatic circulation 1 and excreted entirely into the bile, an ICG clearance test has been used to more precisely assess liver functional reserve before hepatectomy. 2-4 However, actual temporal changes of ICG clearance with regard to LDLT have not been sufficiently investigated. This study had 3 aims. The first aim was to clarify actual changes in ICG clearance after LDLT. Recently, a noninvasive method for...
Liver graft function was better when PVF and graft compliance were higher and PVP was maintained under 20 mmHg.
Summary Sufficiently detailed information on donor safety and the liver regeneration process following right‐lobe living donation has been unavailable, so we evaluated donor outcome and liver regeneration in 13 males and 14 females (39.0 ± 14.8 years old) who provided 27 right‐lobe grafts without the middle hepatic vein. Preoperative total liver volume (TLV), graft volume, and postoperative changes in residual liver volume (RLV) were measured by volumetric computed tomography. Histological steatosis of the liver was graded as none, minimal (≤10%), and mild (11–30%). The median follow‐up period was 337 days. Estimated graft volume and actual graft weight were linearly correlated (Y = 177.85 + 0.795X, R2 = 0.812, P < 0.0001). Graft‐to‐recipient weight ratio was 1.08 ± 0.19%. Four donors had postoperative complications, but they resolved in response to conservative treatment. Postoperative hospital stay was 15.2 ± 5.5 days. Peak liver enzyme values were significantly higher in donors with mild steatosis (n = 7) than without steatosis (n = 16) (P < 0.05). Donor RLV was 40.8 ± 6.6% of original TLV at surgery, 79.8 ± 12.0% by 6 months, and 97.2 ± 10.8% by 12 months. At 3 months the liver of the older donors (≥50 years) had grown significantly more slowly than in younger donors (70.4 ± 9.2% vs. 79.3 ± 9.6%, P = 0.0391). In conclusion, right hepatectomy without middle hepatic vein of living donors is a safe procedure with acceptable morbidity, and the residual liver regenerated to its preoperative size by 1 year. However, meticulous care should be taken in donors with liver steatosis and aged donors.
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