Validity of preoperative volumetric analysis of congestion volume in living donor liver transplantation using three-dimensional computed tomography

Abstract

Reconstruction of middle hepatic vein (MHV) tributaries is controversial in right-lobe living donor liver transplantation (LDLT).L iving donor liver transplantation (LDLT) was developed to overcome the shortage of suitably sized organs from cadaveric donors for children and adults with end-stage liver disease. 1 LDLT necessitates a right-lobe graft for adequate liver volume; however, a right-lobe graft without a middle hepatic vein (MHV) potentially has problems of hepatic venous congestion (HVC) caused by deprivation of drainage from the inferior right hepatic vein (IRHV) and MHV tributaries (V5 and V8). 2 -4 Lee et al. 2 reported 2 cases of severe congestion of a graft without MHV; 1 resulted in sepsis due to congestive infarction and the other developed prolonged massive jaundice. We believe that impaired graft congestion venous outflow was the cause of previously unexplained graft failures during our initial experience of LDLT. Surgeons have agreed on the need of MHV reconstruction because of occasional massive congestion, and so there is an interest in criteria for MHV reconstruction. 3 -5 Further, HVC has been realized only after parenchymal transection and temporary arterial clamping of the donor liver; while preoperative prediction of congestion volume (CV) has been difficult. 5 Recently, preoperative liver volumetry and the measurement of the hepatic vein diameter based on the 3-dimensional computed tomography (3D-CT) has resulted in a significantly improved outcomes, compared to the use of 2-dimensional computed tomography. 6,7 Furthermore, Kishi et al. 8 reported that CV could be calculated and predicted applying new 3D-CT software by calculating the volume from the diameter and length of intrahepatic vascular branches. This study aimed to analyze the efficacy and accuracy of predicting CV and graft volume (GV) based on the software and to evaluate the appropriateness of the reconstruction of these tributaries.

Revisiting the Safety of Living Liver Donors by Reassessing 441 Donor Hepatectomies: Is a Larger Hepatectomy Complication-Prone?

“…In fact, approximately one of every 10 candidate donors for RH was rejected in our institute because his/her preoperative volumetric analysis revealed the remnant liver volume was less than 35% of the total liver volume. Volumetric analyses were done by students in our graduate school who were given only minimum clinical information (35,36). Even a candidate donor whose estimated remnant volume was 34.9% was rejected.…”

A preoperative evaluation for neo-infantile liver tumors using a three-dimensional reconstruction of multidetector row CT

“…In addition, the vessel architecture, including the arterial system and portal venous system were independently demonstrated and reconstructed as each phase analysis. As a volumetric 3D-rendered analysis, the standard liver volume and residual liver volume for several patterns of proposed operation were calculated (1 Table I. Clinical data of each case.…”

Special considerations of living liver donor transplantation

“…A V5, V8 vénás rekonstrukciójának (a törzsek vena cava inferiorhoz tör-ténő bypassának) indikációja és szabályai nem pontosan körülhatároltak, egységes megegyezés még nem szü-letett. A transzplantációs centrumok egy része ajánlásait a preoperatív CT-analízisre bízza [14,27,28], és így a grafton belül észlelhető "megbecsülhető pangás ará-nyát" próbálják minimalizálni [26]. Mások az intraoperatív Doppler-ultrahangos módszer adta eredményekre [29,30] vagy az arteria hepatica átmeneti lefogása [29,31], vagy a vénás törzsek direkt lefogása [32] során lá-tott makroszkópos leletekre hagyatkoznak.…”