Evaluation Of Potential Living Donors Research Articles

Postoperative Imaging Findings of Biliary Atresia

신생아 황달의 주요 원인인 담도폐쇄증은 Kasai portoenterostomy가 기본적인 치료 술식이다. 수술 이후 다양한 합병증이 발생할 수 있는데 portoenterostomy를 통해 발생하는 상행성 담도염이 가장 흔하다. 성공적인 Kasai portoenterostomy 후에도 간 섬유화가 진행할 수 있어 이로 인한 간경화, 문맥 고혈압으로 인한 합병증이 많은 경우에서 발생하게 된다. 합병증이 조절되지 않거나 진행성 고빌리루빈혈증이 있는 경우 간이식을 시행하게 된다. Kasai portoenterostomy 이후 합병증 확인 및 장기 생존 환자의 추적 검사로 다양한 영상 진단이 주요 역할을 하고 있다. 또한 간이식이 필요한 경우 이식 전후로 공여자 및 수혜자 모두에서 수술 금기 확인 및 합병증 조기 발견을 위해 영상 검사들이 중요한 역할을 한다. 초음파 검사가 추적 관찰에 가장 먼저 사용되는 유용한 검사이며 추가적으로 CT 및 MRI를 통해 진단에 도움을 받을 수 있다.

Liver Biopsy Results in Potential Donor Evaluation in Living Related Liver Transplantation

Introduction Living donor liver transplantation has been increasing due to the growing discrepancy between the number of patients in waiting lists for liver transplant and the availability of deceased-donors. The evaluation of potential liver donors should ensure the safety of the surgical procedure for the donor. In addition to this, preoperative tests should identify donor grafts that pose risks for the recipient. Liver biopsy is the gold standard for selecting optimal donors. Our aim in this study is to evaluate the results of preoperative liver biopsy of potential donors. Materials and Methods Between December 1988 and October 2017, we performed 580 LT procedures at our centers (age range, 6 mo – 64 y). We evaluated the demographic features of 612 living related liver donor candidates that we performed liver biopsy between January 2001-June 2017. The histological analyses were examined. Body mass index and gender were compared in predicting the degree of histologically determined steatosis. Results We performed liver biopsy in 612 liver donor candidates (328 male, 284 female) (age range 18-69 years). Among these candidates, 416 liver biopsy were reported as normal (68%); 196 liver biopsies had pathological findings (32%). Of 196 donors with pathological findings; 86 (44%) had fatty changes, 24 (12%) had portal inflammation, 86 (44%) had other pathological findings (like fibrosis, hepatitis, focal spotty necrosis). The mean BMI with steatosis were much more higher than the mean BMI without steatosis (29.7± 3.6 vs 24.8 ± 4.2) ( p<.001). 25% of male and 15% of female donor candidates had steatosis. Conclusion The high rate of pathological findings in liver biopsy of donor candidates with healthy-appearing livers pointed the importance of liver biopsy in preoperative evaluation of donors.

Additive value of non-contrast MRA in the preoperative evaluation of potential liver donors

The purpose of this study is to compare diagnostic quality, inter-observer variability and agreement of non-contrast enhanced MRA (NC-MRA) with contrast-enhanced MRA (CE-MRA) in the evaluation of hepatic arterial anatomy. 20 potential liver donors were included in this retrospective study. NC-MRA, CE-MRA and combined data sets were randomized and reviewed by two readers. Reference standard was consensus by two senior radiologists using all data including CTA. There was no difference in IQ or diagnostic confidence between NC-MRA, CE-MRA or combined data for either reader but the arterial origin of segment IV was successfully identified on NC-MRA when CE-MRA was suboptimal.

Preoperative CT evaluation of potential donors in living donor liver transplantation.

Living donor liver transplantation is an effective, life sustaining surgical treatment in patients with end-stage liver disease and a successful liver transplant requires a close working relationship between the radiologist and the transplant surgeon. There is extreme variability in hepatic vascular anatomy; therefore, preoperative imaging of potential liver donors is crucial not only in donor selection but also helps the surgeons in planning their surgical approach. In this article, we elaborate important aspects in evaluation of potential liver donors on multi-detector computed tomography (MDCT) and the utility of MDCT in presurgical assessment of the hepatic parenchyma, relevant hepatic vascular anatomy and segmental liver volumes.

P925 RECIPIENTS WITH NASH HAVE HIGHER PREVALENCE AND MORE SEVERE CORONARY ARTERY DISEASE COMPARED TO HCV-INFECTED PATIENTS

Background and Aims: The evaluation of potential liver donors for transplantation is based in the careful analysis of the clinical, biochemical and histological data. In our center, liver biopsy is performed systematically to minimize the risk of the recipient to receive a suboptimal organ. The aim is to evaluate the main histological findings responsible for the exclusion of livers that were previously selected. Methods: Retrospective study of histological findings in livers for transplantation excluded based on histological criteria. Demographics, laboratory data and the cause of death were collected. Results:We excluded 110 organs from donors, mean age of 46 years, mostly male (59%). Fatty liver disease was the major cause of exclusion, presented as isolated macrovesicular steatosis in 59 patients and steatohepatitis in 5. The Body Mass Index (BMI) was a poor marker for the presence of steatosis since 80% of patients excluded for this had BMI below 25 kg/m. Fibrosis was identified in 22 patients, of which 3 had cirrhosis. Degenerative processes associated with ischemia time excluded 10 livers. Lesions consistent with chronic hepatitis were found in 5 cases. The least common causes were the presence of hepatic granulomas (4patients), hydatid cysts (two cases) and one case of autoimmune hepatitis. Transaminases and cholestasis enzymes did not correlate with histological findings. Conclusions: Liver biopsy before transplantation represents an important complementary test for the success of liver transplantation. The realization of biopsy enables the exclusion of histological changes in patients considered potential donors, thereby decreasing the risk of early and late organ failure. P925 RECIPIENTS WITH NASH HAVE HIGHER PREVALENCE AND MORE SEVERE CORONARY ARTERY DISEASE COMPARED TO HCV-INFECTED PATIENTS S.K. Satapathy, A.C. Flowers, J.M. Vanatta, N. Dbouk, S.P. Nair, J. Eason. Methodist University Hospital, University of Tennessee Health Sciences Center, Internal Medicine, Methodist University Hospital, University of Tennessee Health Sciences Center, Memphis, TN, United States E-mail: aflowe11@uthsc.edu

Role of three-dimensional multidetector computed tomography angiography of hepatic vessels in the evaluation of living donors

Objectives To assess the role of multidetector computed tomography (MDCT) angiography in the preoperative mapping of hepatic vascular anatomy in potential living liver donors, identification of anatomical variants that influence the donor selection and surgical planning. Background Liver transplantation became the ultimate solution for decompensating liver diseases. Donor's safety and selection protocols are primary concerns. Thus, preoperative evaluation of the hepatic vascular anatomy is crucial to minimize mortality, morbidity, and post-transplant complications. Patients and methods Evaluation of 20 potential living donors was performed using 64-row MDCT scanners, obtaining hepatic arterial and portovenous phases. The arterial anatomy was classified according to the Michels classification. The portal venous anatomy was assessed and classified according to the Cheng classification. The hepatic venous anatomy was evaluated with special attention paid to the middle hepatic vein anatomy. Results In our study, out of 20 liver transplantation potential donors, 11 (55%) showed a classic arterial anatomy, whereas nine (45%) showed some type of anatomical variant. Replaced right hepatic artery from the superior mesenteric artery was the most common (three donors, 15%). The classic portal venous anatomy was found in 16 candidates (80%), whereas its variants were detected in four cases (20%). The standard hepatic venous anatomy was found in 14 candidates (70%). Six individuals (20%) had significant accessory hepatic veins. Middle hepatic vein confluence was late in four candidates (20%). An accessory inferior right hepatic vein was the most common accessory hepatic vein that was detected in five cases (25%). Conclusion 64-row MDCT is essential in the preoperative evaluation of potential liver donors. It is a noninvasive comprehensive evaluation tool that can show the hepatic vascular anatomic details with precise relationship to the liver parenchyma.

Pre-operative hepatic vascular mapping of living donor for liver transplantation using 64-MDCT

ObjectiveThe purpose of the present study was to assess the performance of 64-row MDCT angiography in the mapping of hepatic vascular anatomy in potential living liver donors with special attention paid to the anatomical variants, which influence the donor selection and surgical planning. Material and MethodsEvaluation of 43 potential living donors was performed using 64-row MDCT scanner to obtain hepatic arterial and venous phases. Eleven subjects were excluded as they did not perform the transplantation surgery. The hepatic arterial (HA) anatomy was evaluated and classified according to Michel classification with special attention given to those considered relative or absolute contraindications for donation and those may alternating the surgical procedure. The origin and course of the artery to segment IV were determined. Portal venous (PV) anatomy was assessed and classified according to Cheng classification. Hepatic venous anatomy was evaluated with special attention paid to middle hepatic vein (MHV) anatomy, significant accessory branches crossing dissection line or that may require additional anastomosis. Results64-Row MDCT was done for 43 potential living donors. Eleven subjects were excluded as they did not perform the transplantation surgery. Thirty-two living donors for liver transplantation were enrolled in this study. Standard hepatic arterial anatomy was determined in 19 subjects (59.4%) while 13 candidates (40.6%) showed hepatic arterial variations. The replaced RHA arises from the SMA was the commonest (n=5, 15.6%). The dominant artery to segment IV was a branch from the left hepatic artery (LHA) in 24 cases (75%) and from right hepatic artery in 8 cases (25%). Classic portal venous anatomy was found in 26 candidates (81.2%) while its variants were detected in 6 cases. Standard hepatic venous anatomy was found in 21 candidates (65.6%). A total of 11 subjects (34.4%) showed hepatic venous variants. 8 cases (25%) had single significant accessory hepatic vein while 3 subjects (9.4%) had two or more significant accessory hepatic veins. MHV confluence was late in 4 candidates (12.5%). An accessory inferior right hepatic vein was the commonest accessory hepatic vein that was detected in 7 cases (21.9%).Compared to surgical findings, MDCT correctly identified hepatic arterial and portal venous anatomy in all cases with no false positive or false negative cases. Sensitivity, specificity, PPV, NPV and accuracy of MDCT in identification of hepatic arterial and portal anatomy were all 100% while for hepatic venous anatomy, the corresponding values were 83.3%, 100%, 100%, 90.1% and 93.8%, respectively. Conclusion64-Row MDCT is an essential part of pre-operative evaluation of potential liver donors. It is a non-invasive comprehensive evaluation tool that can show the hepatic vascular anatomic details with precise relationship to liver parenchyma.

Imaging of hepatic steatosis and fatty sparing: a review

Radiology has gained importance in the noninvasive diagnosis of hepatic steatosis. Ultrasonography is usually the first imaging modality for the evaluation of hepatic steatosis. Unenhanced computed tomography (CT) with or without dual kVp measurement and magnetic resonance imaging (MRI) with in- and out-of-phase sequence can allow objective evaluation of hepatic steatosis. However, none of the imaging modalities can differentiate nonalcoholic steatohepatitis/fatty liver disease from simple steatosis. Evaluation of hepatic steatosis is important in donor evaluation before orthotopic liver transplantation and hepatic surgery. Recently, one-stop-shop evaluation of potential liver donors has become possible by CT and MRI, integrating vascular, parenchymal, volume, and steatosis evaluation. Moreover, hepatic steatosis (diffuse, multinodular, focal, subcortical, perilesional, intralesional, periportal, and perivenular), hypersteatosis and sparing (geographic, nodular, and perilesional or peritumoral) can cause diagnostic problems as a pseudotumor, particularly in the evaluation of oncology patients. Liver MRI is used as a problem-solving tool in these patients. In this review, we discuss the current role of radiology in diagnosing and quantifying hepatic steatosis and solutions for diagnostic problems associated with fatty infiltration and sparing. Radiology has gained importance in the noninvasive diagnosis of hepatic steatosis. Ultrasonography is usually the first imaging modality for the evaluation of hepatic steatosis. Unenhanced computed tomography (CT) with or without dual kVp measurement and magnetic resonance imaging (MRI) with in- and out-of-phase sequence can allow objective evaluation of hepatic steatosis. However, none of the imaging modalities can differentiate nonalcoholic steatohepatitis/fatty liver disease from simple steatosis. Evaluation of hepatic steatosis is important in donor evaluation before orthotopic liver transplantation and hepatic surgery. Recently, one-stop-shop evaluation of potential liver donors has become possible by CT and MRI, integrating vascular, parenchymal, volume, and steatosis evaluation. Moreover, hepatic steatosis (diffuse, multinodular, focal, subcortical, perilesional, intralesional, periportal, and perivenular), hypersteatosis and sparing (geographic, nodular, and perilesional or peritumoral) can cause diagnostic problems as a pseudotumor, particularly in the evaluation of oncology patients. Liver MRI is used as a problem-solving tool in these patients. In this review, we discuss the current role of radiology in diagnosing and quantifying hepatic steatosis and solutions for diagnostic problems associated with fatty infiltration and sparing.

Evaluation of potential liver donors: Limits imposed by donor variables in liver transplantation

The aim of this study was to evaluate the predictive value of different donor and recipient parameters that have been recognised previously as proven and to suggest prognostic factors for immediate liver function and final outcome after liver transplantation. We evaluated a total of 228 liver grafts transplanted in the last 3 years in our institution. Parameters were recorded for the donor (age, polytransfusion, atherosclerosis, presence of infection, episodes of hypoxia or hypotension, use of vasoactive drugs, intensive care unit stay, steatosis, and ischemia time) and recipient (red blood cell requirements, immediate liver function [score], incidence of hepatic artery thrombosis, survival, and cause of death or retransplantation). Liver biopsy after reperfusion of the donor liver was performed before closure of the abdomen. Donor age over 65 years and presence of steatosis were associated significantly with initial poor function. The mortality rate at 6 months was related to donor age over 65 years. When donor age over 65 years was combined with transfusion requirement of > 10 U of red blood cells (RBC), the incidence of graft loss increased to 53%. The probability of graft survival at two years decreased when donor age was over 65 years. Moreover, when donor age over 65 years was combined with requirement of > 10units RBC the probability of 2-year survival was significantly reduced. This study shows, for the first time, that the use of donor livers from older donors in liver transplant procedures, requiring more than 10 U of RBC, results in a significantly worse prognosis in terms of immediate liver function and long-term survival. (Liver Transpl 2003;9:389-393.)

Right-lobe living related liver transplantation: evaluation of a comprehensive magnetic resonance imaging protocol for assessing potential donors.

The purpose of this study was to determine the practicability and diagnostic accuracy of a magnetic resonance (MR) protocol capable of replacing computed tomography, catheter angiography, and endoscopic retrograde cholangiopancreatography for the presurgical evaluation of potential liver donors before right hepatectomy. MR imaging (MRI) was performed on a 1.5 T scanner using a phased-array torso surface coil for signal reception. The following image sets were collected: axial two-dimensional (2D) T1-weighted fast low angle shot (FLASH), axial 2D T2-weighted half-Fourier acquisition single-shot turbo-spin-echo (HASTE) with fat saturation, coronal MR cholangio-pancreatography (MRCP) based on 2D multisection HASTE and single-section single-shot rapid acquisition with relaxation enhancement (RARE) imaging, dynamic contrast-enhanced three-dimensional (3D) FLASH, and contrast-enhanced T1-weighted FLASH. 3D FLASH data sets were collected before and after an intravenous administration of Multihance (gadobenate dimeglumine, Gd-BOPTA; Bracco, Milano, Italy), 0.2 mmol/kg of body weight. Thirty-eight potential liver donors were assessed by means of MRI. Twenty patients also underwent digital subtraction angiography (DSA). Of these, 16 patients underwent liver harvesting. MR angiography (MRA) data sets correlated with DSA results, and MRCP results correlated with intraoperative findings. Patients were excluded as potential donors based on insufficient liver mass of the left hepatic lobe (n = 5) or presence of hepatic pathological states (n = 9) seen at MRI, such as hemangiomas, focal nodular hyperplasias, or hepatic steatosis. MRCP showed the biliary system to the level of the first hepatic side branch. Dilated ducts were present in 4 patients. MRA depiction of hepatic arterial morphological characteristics correlated with catheter angiography results in all 20 patients: Three left hepatic arteries originating from the left gastric artery, three aberrant right hepatic arteries originating from the superior mesenteric artery, and two aberrant origins of both hepatic arteries and one common hepatic artery originating from the superior mesenteric artery were correctly identified on MRA. Similarly, the portal venous system was fully assessed on MRA. A comprehensive assessment of the hepatic parenchyma, biliary and pancreatic ductal system, and hepatic arterial, portal, and venous systems can be accomplished using the outlined protocol.

Evaluation of potential liver donors: expanding donor criteria?

Evaluation of potential liver donors: expanding donor criteria?