Abstract
O447 Aims: Proprietary software has been recently developed that dramatically improves preoperative and postoperative evaluation of live donor liver anatomy and regeneration. Better understanding of the determinants and dynamics of liver regeneration after right lobe live donor hepatectomy may lead to optimization of surgical technique and improve the ability to predict expected regeneration in an individual patient. Methods: Dynamic spiral CT was performed preoperatively and postoperatively in right lobe liver donors at 1week, 4 weeks, 3, 6 and 12 months after donation. Digital image data analysis was performed on 10 donors using proprietary software (Hepavision2, MeVis, Bremen, Germany). Semi-automatic quantification of total liver volume, true anatomic portal venous territory volume as well as portal venous branch length in regenerating liver segments was performed. Results: We derived a power law behaviour for the volume growth of true vascular territories in the remnant liver lobe. This means that the increase in portal venous branch length scales with the third root of the increase of territorial volume over time. An example of 3-dimentional renderings of remnant volumes and portal vein length at different time points in a donor are shown below.FigureLegend:Left image shows donor liver split into Graft (blue) and Remnant (red) along dotted line, numbers denote borders of regenerating remnant at specific time points (#1: 1week[536cc], #2: 4weeks[484cc], #3: 6months[564cc], #4: 12months[587cc]. Right image shows corresponding superimposed growing portal veins in regenerating remnant liver, each color denotes different point in time. Conclusions: From a macroscopic viewpoint, donor liver regeneration is characterized by scaled growth of existing vessels and territorial volumes. This means that liver regeneration is a “scaling phenomenon” that can be predicted mathematically. Territorial plasticity of liver regeneration was found to be dependent on the absence of postoperative venous compromise of the remnant lobe. Additional studies are needed to further elucidate the determinants of liver regeneration.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call