Liver regeneration after living adult right lobe transplantation.

BACKGROUND: The purpose of this study was to describe liver regeneration in patients undergoing living-adult liver transplantation. METHODS: This prospective study included 10 donors and eight recipients who had a total of 65 computed tomographic (CT) scans. All patients had preoperative CT ( n = 18), and follow-up CT scans ( n = 47) were obtained for up to 14 months after transplantation. Liver and spleen volumes were measured by hand tracing each organ on the axial portal venous phase images. RESULTS: Both donors and recipients showed immediate increases in liver volume. However, liver regeneration was significantly faster and reached a higher peak in recipients than in donors. Splenic volume in donors demonstrated an initial increase followed by a decline, reaching the preoperative volume after 1 year. Splenic volume in recipients demonstrated immediate decline postoperatively. CONCLUSION: Restoration of liver volume occurred rapidly after transplantation, but followed different patterns in donors and recipients. Deviation from these patterns warrants further investigation.

Accuracy of volumetric measurements after virtual right hepatectomy in potential donors undergoing living adult liver transplantation.

OBJECTIVE: The purpose of this study was to evaluate accuracy for determining the total and lobar liver volumes using a multidetector CT scanner in potential donors undergoing living adult right lobe liver transplantation. SUBJECTS AND METHODS: Fifty-two adult donors underwent CT using a multidetector scanner after IV injection of 180 mL of contrast material. For volumetric determination, portal venous phase images were acquired at 60 sec. Hand-tracing was used to isolate the entire liver, and a curved hepatectomy plane was then identified in a manner simulating the surgical incision. Two observers performed hand-tracing of the entire liver to calculate total liver volume, and of the right lobe to calculate expected graft volume. RESULTS: The mean volume of the entire liver, right lobe, and left lobe was 1807 mL, 990 mL, and 817 mL, respectively, for observer 1, and 1788 mL, 1007 mL, and 781 mL, respectively, for observer 2. There was significant agreement between the two observers in determining total and lobar liver volumes (r = 0.996, 0.977, and 0.965 for total, right lobe, and left lobe volumes, respectively; p< 0.0001). There was no statistically significant difference between the two observers in measuring total or lobar liver volumes (p< 0.0001). There was significant agreement between right lobe volume measured by each observer and graft weight obtained in 14 donors at surgery (r = 0.898 and 0.879, for observers 1 and 2, respectively; p <0.001). CONCLUSION: Total and lobar volume determinations after virtual right hemihepatectomy provides accurate and reproducible information that is critical in selecting potential living liver donors.

Impact of multidetector CT on donor selection and surgical planning before living adult right lobe liver transplantation.

OBJECTIVE: This study was performed to document the impact of multidetector multiphase CT in facilitating patient selection and surgical planning in potential donors being evaluated for living adult right lobe liver transplantation. SUBJECTS AND METHODS: Forty consecutive potential donors were included in the study. There were 26 men and 14 women, (age range, 18-57 years; mean, 37 years) We performed CT using a multidetector scanner, after IV injection of 180 mL of contrast material at 5 mL/sec. Arterial phase images were acquired at 18 sec (collimation, 1.25 mm; table speed, 7.5) and portal phase images, at 60 sec (collimation, 2.5 mm; table speed, 15). Postprocessing was performed on a commercially available workstation. CT data included dual-energy assessment of liver parenchyma for fatty infiltration; depiction of arterial, portal venous, and hepatic venous anatomy and identification of important vascular variants; and determination of total and lobar liver volume. RESULTS: Of the 40 potential liver donors evaluated, 15 patients (37.5%) were excluded on the basis of CT findings, with most exclusions a result of portal vein anomalies (n = 8). Fatty infiltration resulted in four exclusions (10%), and small liver volume resulted in three exclusions (7.5%). CONCLUSION: Multidetector multiphase CT provided comprehensive parenchymal, vascular, and volumetric preoperative evaluation of potential donors undergoing living adult right lobe liver transplantation. This information had a major impact on patient selection because it was used to stratify patients. It allowed the surgeons to plan their surgical approach, and this planning may reduce postoperative complications.