Hepatic venous congestion in living donor liver transplantation: preoperative quantitative prediction and follow-up using computed tomography.
Hepatic venous congestion (HVC) has not been assessed quantitatively prior to hepatectomy and its resolving mechanism has not been fully analyzed. We devised and verified a new method to predict HVC, in which HVC was estimated from delineation of middle hepatic vein (MHV) tributaries in computed tomography (CT) images. The predicted HVC was transferred to the right hepatic lobes of 20 living donors using a paper scale, and it was compared with the actual observed HVC that occurred after parenchymal transection and arterial clamping. The evolution of HVC from its emergence to resolution was followed up with CT. Volume proportions of the predicted and observed HVC were 31.7 +/- 6.3% and 31.3 +/- 9.4% of right lobe volume (RLV) (P =.74), respectively, which resulted in a prediction error of 3.8 +/- 3.7% of RLV. We observed the changes in the HVC area of the right lobes both in donors without MHV trunk and in recipients with MHV reconstruction. After 7 days, the HVC of 33.5 +/- 7.7% of RLV was changed to a computed tomography attenuation abnormality (CTAA) of 28.4 +/- 5.3% of RLV in 12 donor remnant right lobes, and the HVC of 29.1 +/- 11.5% of RLV was reduced to a CTAA of 9.3 +/- 3.2% of RLV in 7 recipient right lobe grafts with MHV reconstruction. There was no parenchymal regeneration of the HVC area in donor remnant livers during first 7 days. In conclusion, we believe that this CT-based method for HVC prediction deserves to be applied as an inevitable part of preoperative donor evaluation. The changes in CTAA observed in the right lobes of donors and recipients indicate that MHV reconstruction can effectively decrease the HVC area.
Hwang
Shin
S
Department of Surgery, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea.
Lee
Sung-Gyu
SG
Park
Kwang-Min
KM
Kim
Ki-Hun
KH
Ahn
Chul-Soo
CS
Lee
Young-Joo
YJ
Sung
Kyu-Bo
KB
Moon
Deok-Bog
DB
Ha
Tae-Yong
TY
Cho
Sung-Hun
SH
Oh
Ki-Bong
KB
Han
Ji-Min
JM
Kim
Myung-Hwan
MH
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008102:Liver Circulation; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011379:Prognosis; D020858:Tissue and Organ Harvesting; D014057:Tomography, X-Ray Computed