Subject(s)
Hepatectomy , Liver Transplantation , Liver/physiology , Living Donors , Adolescent , Adult , Analysis of Variance , Blood Loss, Surgical , Blood Transfusion, Autologous , Child , Child, Preschool , Hepatectomy/adverse effects , Hepatectomy/methods , Humans , Infant , Liver Function Tests , Middle Aged , Postoperative Care , Risk FactorsABSTRACT
BACKGROUND: There is a potentially significant risk to the donor in living-related liver transplantation. METHODS: We analyzed surgical risk and stress to 35 donors in living-related liver transplantation with special reference to the types of donor hepatectomy. Donor surgery was performed in one of three ways: (1) lateral segmentectomy without ligation of the middle hepatic vein (MHV) in the remnant liver (group 1, n=21); (2) lateral segmentectomy with ligation of MHV in the remnant liver (group 2, n=6); and (3) left lobectomy with MHV (group 3, n=8). RESULTS: No critical complications were observed in any group. The postoperative enzyme levels in group 2 were significantly higher than those in groups 1 and 3 (P<0.01). Although blood loss was covered by autologous blood transfusion in the first six cases, no banked blood was transfused in any of the cases. Surgical duration was significantly longer and blood loss was significantly greater in group 3 than in group 1 (P<0.05). Follow-up computed tomography showed atrophic changes in segment IV in groups 1 and 2. No remarkable changes were seen in segments V or VIII in any of the three groups. CONCLUSION: Regardless of the donor hepatectomy procedure, serious complications did nor occur after surgery. Although it should be noted that the type of donor hepatectomy affects postoperative donor liver function, left lateral segmentectomy with ligation of MHV in the remnant liver is a useful method for obtaining liver grafts from living-related donors who have unusual anatomic variations of the hepatic veins.
Subject(s)
Liver Transplantation , Liver/physiopathology , Living Donors , Adult , Atrophy , Child, Preschool , Female , Follow-Up Studies , Hepatectomy/methods , Humans , Infant , Liver/diagnostic imaging , Liver/enzymology , Liver/pathology , Male , Organ Size , Postoperative Complications , Postoperative Period , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
After injecting 100 ml of a saline solution into the hepatic artery of 27 livers evidencing a hepatocellular carcinoma, samples from the resected livers were collected through the portal and the hepatic vein. Cancer cells were detected in 4 out of 27 samples from the portal vein and in 1 out of 19 samples from the hepatic vein, and the total number of positive cases were 4. Further, tumors over 5 cm in diameter showed a tendency of flowing cancer cells into the portal vein. Four positive cases had an intrahepatic and a distant metastasis within one year of their operation and two of these patients died.
