title: Computer-assisted surgical planning in adult-to-adult live donor liver transplantation: how much does it help? A single center experience.
abstract: BACKGROUND
  Preoperative imaging and donor selection are cardinal components of adult-to-adult live donor liver transplantation (ALDLT). The purpose of this study was to evaluate our three-dimensional (3D) computed tomography image-derived computer-assisted surgical planning (3D CASP) in ALDLT.
  
  
  METHODS
  Eighty-three consecutive ALDLTs (71 right and 12 left) were planned with 3D CASP. Graft, remnant, and total liver volume compliance were calculated and compared with actual intraoperative values. Computed risk analysis encompassing territorial liver mapping, functional (safely drained) volumes, and outflow congestion volumes in grafts and remnants allowed for the individualized management of the middle hepatic vein (MHV).
  
  
  RESULTS
  Graft volume compliance was 13.5%±4.4%. Three small-for-size (SFS) grafts with lethal SFS syndrome (SFSS) had nonsignificant volume compliance with maximal graft volume-body weight ratios of less than 0.83. Seven SFS grafts with reversible or absent SFSS showed maximal graft volume-body weight ratios of 0.9 to 1.16. Significant differences were identified for (a) virtual graft and remnant congestion volumes of risky versus nonrisky MHV types (49%±6% and 34%±7% vs. 29%±8% and 33%±12%, P<0.001 and P<0.02, respectively) and (b) virtual mean functional versus surgical volumes of grafts (527±119 vs. 963±176 mL, P<0.0001) and remnants (419±182 vs. 640±213 mL, P<0.001).
  
  
  CONCLUSIONS
  CASP allowed for (a) prevention of SFSS in extremely small grafts by predicting donor liver plasticity and (b) individualized MHV management for both donors and recipients based on functional graft/remnant volume analysis.
authors.affiliation: Department of General, Thoracic and Transplantation Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Arnold
authors.initials: A
authors.lastname: Radtke
authors.forename: George
authors.initials: G
authors.lastname: Sgourakis
authors.forename: Ernesto P
authors.initials: EP
authors.lastname: Molmenti
authors.forename: Susanne
authors.initials: S
authors.lastname: Beckebaum
authors.forename: Vito
authors.initials: V
authors.lastname: Cicinnati
authors.forename: Christoph E
authors.initials: CE
authors.lastname: Broelsch
authors.forename: Heinz-Otto
authors.initials: HO
authors.lastname: Peitgen
authors.forename: Massimo
authors.initials: M
authors.lastname: Malagó
authors.forename: Tobias
authors.initials: T
authors.lastname: Schroeder
mesh_terms: D000328:Adult; D046148:Donor Selection; D005260:Female; D005858:Germany; D006801:Humans; D021621:Imaging, Three-Dimensional; D008099:Liver / Q000000981:diagnostic imaging* / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009929:Organ Size; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011857:Radiographic Image Interpretation, Computer-Assisted; D018570:Risk Assessment; D012307:Risk Factors; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome