Living Liver Donor Transplantation Research Articles

CT Angiographic Study on the Variations of the Hepatic Arteries in the Living Liver Donors of the South Indian Population.

Living liver donor transplantation is the last option for the end stage liver diseases. The variations in the hepatic artery of the liver donor may lead to poor outcome, or may end with major post-operative complications such as hepatic artery thrombosis. To prevent the post-operative complications and to increase the success rate of the liver transplant surgeries, CT evaluation of the hepatic arteries is essential. Thus, the present study was aimed to study the variations of the hepatic arteries in the living liver donors. A total of 200 CT angiograms were collected from the department of Radiology from August 2018 to December 2021, and the evaluation was carried out in the Department of Anatomy, Deccan College of Medical Sciences, Hyderabad. All the CT angiograms were studied for the variations of hepatic arterial system, and the observed variations were noted and the incidence was calculated. The normal anatomy was observed in 62.5% liver donors and 37.55% of liver donors showed variations in hepatic arterial pattern. The incidence of the replaced left hepatic retry, replaced right artery, replaced left along with replaced right hepatic artery was observed as 11.5%, 9.5% and 3% respectively. The incidence of left and right accessory hepatic arteries was 7% and 4% respectively and the replaced right hepatic artery with accessory left hepatic artery was observed in 1.5% cases. The variations observed in the hepatic arterial pattern observed in this study could be helpful to the surgeons, while planning and selecting the suitable liver donors and also may minimise the risk and increase the success rate.Â

Magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF) is a viable alternative to liver biopsy for steatosis quantification in living liver donor transplantation.

This study aimed to investigate whether magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF) can be a viable noninvasive alternative to liver biopsy for the quantification of living liver donor steatosis. Hepatic steatosis for 143 donors was graded by MRI-PDFF. Study endpoints included liver volume regeneration in donors, recipient outcomes including length of hospital stay, deaths, primary non-function (PNF), early allograft dysfunction (EAD), and small for size syndrome (SFSS). Correlation between MRI-PDFF determined donor steatosis and endpoints were analyzed. Donors had lower steatosis grade than non-donors. Donor remnant liver regenerated to an average of 82% of pre-donation volume by 101±24days with no complications. There was no correlation between percent liver regeneration and steatosis severity. Among recipients, 4 underwent redo-transplantation and 6 died, with no association with degree of steatosis. 52 recipients (36%) fulfilled criteria for EAD (driven by INR), with no difference in hepatic steatosis between groups. MRI-PDFF reliably predicted donor outcomes. Living donors with no or mild steatosis based on MRI-PDFF (ie, <20%) and meeting other criteria for donation can expect favorable post-surgical outcomes, including liver regeneration. Recipients had a low rate of death or retransplantation with no association between mild hepatic steatosis and EAD.

Liver Transplantation Reverses Hepatic Myelopathy in 2 Children With Hepatitis A Infection.

Objectives:To report 2 children with acute hepatic myelopathy after hepatitis A infection who recovered completely after living donor liver transplantation.Methods:All the children admitted into liver intensive care unit (LICU) from November 1st 2018 to 31st October 2019, were evaluated for the neurological features. The data was collected from the admission register of the LICU unit in children below 15 years age. Medical records of these children were reviewed and data collected. Established clinical criteria were used to categorize the various grades of hepatic encephalopathy/myelopathy.Results:37 children were seen over 1-year period between 6 months to 15 years age. There were 24 male(64.9%) and 13 females. Acute liver failure was seen in 19 (51.3%) and acute on chronic liver failure in 18 (48.7%). There were 10 cases of hepatitis A in acute liver failure group,10 of 19 cases (52.6%), while Wilson’s disease and undetermined etiology group formed the chronic group. 2 cases of hepatic myelopathy were seen in acute liver failure following hepatitis A infection. Both these children underwent live liver donor transplantation and recovered completely. Further in hepatitis A group,3 children had spontaneous recovery, 4 died and 1 child was discharged with end of life care. Overall out of all 37 children with liver failure,20 (54%) were discharged, 6 (16.2%) were advised end of life care and 11 (29.8%) died.Conclusion:Two cases (10.5%) of reversible hepatic myelopathy were seen in acute liver failure group of 19 cases. 18 out of 37 (48.6%) children had residual neurological features at discharge time.

IS THE MERIT OF BECOMING A LIVING LIVER DONOR ENOUGH?

Introduction: Due the shortage of deceased donation, living liver donor transplantation has been widely used. The aim of this study is to evaluate the emotional states of the living liver donor’s (LLD) after the donation. Materials and Methods: Since 1988, we performed 652 liver transplantation (443 living donor, 209 deceased donor liver transplantation) at Başkent University. Among 443 living donors, 62 LLDs agreed to participate in the study. All data were collected by a questionnaire form designed by the researchers according to the related literature. The questionnaire form included socio-demographic data as well as Patient Health Questionnaire 2 (PHQ-2) and Generalized Anxiety Disorder Questionnaire (GAD-2). Results: 62 LLD who fulfilled the form were included in the study. The mean age of the participants was 44,39±9,33 years (61,3% female and 38,7% male). 46,77% of LLDs had primary school education and 93,5% of them were married. The majority of the LLDs were mothers (45,2%, p<0,01). When LLDs learned that they can donate, the declared emotional reactions were happiness (46,8%), the feeling of the responsibility (16,1%), anxiety (12,9%), hesitation (9,7%) and fear (8,1%) respectively. The emotional reaction of the happiness found to be higher in male LLDs (F 34.2%; M 66,7%). Female LLDs dominated the other reactions higher than men. The score of the PHQ-2 test showed that LLDs were in depressive state at the time of the questinnaire (F 1,56±0,21; M 1,60±0,42). The percentage of female participants who were questioning their decision to become a LLD was found higher (63,2%) than males. The scores regarding the possibility of the psychological pressure at the time of donation showed that LLDs had felt psychological pressure (F 1,41±0,49; M 1,00±0,54). Conclusion: Being a donor causes psychological and social pressure. Harvesting a healthy individual should not be seen as a more feasable therapy for end stage organ failure. Deceased-donor organ transplantation should be the preferred treatment.

Use Of Coronary CTA For Cardiovascular Risk Assessment In Potential Live Liver Donors

Introduction: Over 2000 liver transplant candidates die each year while waiting for an organ. Living liver donor transplantation can play a significant role in expanding the availability of livers however, transplant programs must minimize risk to potential liver donors. The 2012 consensus document from the AST/ASTS/NATCA/UNOS Joint Societies Work Group states that clinically significant cardiovascular disease is a relative contraindication to live liver donation, with methodology, assessment and risk tolerance at the discretion of each transplant center. At the University of Colorado , we developed a protocol which integrates coronary CTA (CCTA) for cardiovascular risk assessment in potential living liver donors. We report our initial experience with this approach.

Impact of Donor and Recipient Single Nucleotide Polymorphisms in Living Liver Donor Transplantation for Hepatitis C

IntroductionRecently, several studies have shown that specific single nucleotide polymorphisms (SNPs) affect liver fibrosis progression in patients with hepatitis C virus (HCV) infection. In this study, we examined the impact of donor and recipient SNPs on the progression of fibrosis after liver transplantation for HCV infection. MethodsThis cohort study enrolled 43 patients with HCV infection who underwent liver transplantation at our hospital. We evaluated 5 genotypes (rs4374383, rs2629751, rs9380516, rs8099917, and rs738409) that have been reported to be significant predictors of fibrosis in HCV infection using a Taqman assay. ResultsLiver fibrosis (stage ≥ F1, New Inuyama classification) was detected at 1 year after liver transplantation in 30 cases (70%). The rs2629751 non–AA-genotype was found to be significantly associated with fibrosis progression at 1 year after liver transplantation (AA:GG or GA = 46%:88%, P < .05). The primary outcome was stage ≥F2 (portoportal septa) or liver-related mortality in 22 patients. The time to stage ≥F2 fibrosis or liver-related mortality was significantly different only in terms of the donor rs2629751 genotype (AA:GG or GA = 5.5 ± 0.6 years:3.6 ± 0.7 years, P = .025). ConclusionsThe rs2629751 genotype may be an important predictor of posttransplant outcome in HCV-infected patients. This result might be useful in donor selection for liver transplantation in HCV-infected patients and may guide therapeutic decisions regarding early antiviral treatment.

Hepatic Artery Thrombosis in Live Liver Donor Transplantation: How to Solve–A Case Report

The decrease in the number of cadaveric donors has proved a limiting factor in the number of liver transplants, leading to the death of many patients on the waiting list. The living donor liver transplantation is an option that allows, in selected cases, increase the number of donors. One of the most serious complications in liver transplantation is hepatic artery thrombosis, in the past considered potentially fatal without urgent re-transplantation. A white male patient, 48 years old, diagnosed with hepatocellular carcinoma in chronic liver failure caused by hepatitis B virus, underwent living donor liver transplantation (right lobe). Doppler echocardiography performed in the immediate postoperative period did not identify arterial flow in the right branch, having been confirmed thrombosis of the right hepatic artery in CT angiography. Urgent re-laparotomy was performed, which consisted of thrombectomy and re-anastomosis of the hepatic artery with segmental splenic artery allograft interposition. The patient started anticoagulation and antiplatelet therapy with acetylsalicylic acid. Serial evaluation with Doppler echocardiography showed hepatic artery patency. At present, the patient is asymptomatic. One of the most devastating complications in liver transplantation, and particularly in living liver donor, is thrombosis of the hepatic artery; thus, early diagnosis and treatment is vital. The rapid intervention for revascularization of the graft avoids irreversible ischemia of the bile ducts and hepatic parenchyma, thus avoiding the need for re-transplantation.

Special considerations of living liver donor transplantation

Due to the limited number of cadaver donors, adult living liver donor transplantation became an alternative for liver transplantation. During living liver donor transplantation, the safety and uncomplicated recovery of the donor are as important as the appropriate volume and weight of the donated graft. The middle hepatic vein causes a significant dilemma, due to the special anatomical position. The reconstruction of the middle hepatic vein branches supplying S5, S8 is suggested when the anatomically right liver lobe is transplanted. The aim of the present study was to investigate the requirements of the reconstruction of middle hepatic vein and to give an accurate description about the discrepancy between the portal vein in- and outflow. The authors analyzed the liver anatomic characteristics of 130 donors undergoing living liver donor transplantation with the use of MeVis software. The so-called porto-hepatic disparity index (shift) was introduced. The right hepatic vein was dominant in 64.6% of all cases, while the left hepatic vein was never observed to be dominant. The territories of V5 and V8 were responsible for the 33.2±8.9% of the right hepatic lobe area. The correlation between portal venous territory and vein dominancy were as follows: R2 = 0.7811 in the left liver lobe; R² = 0.5463 in the area of middle hepatic vein and R² = 0.5843 in the case of the right hepatic vein. The average value of the shift was 28.2%. The differences among the pattern of portal in- and hepatic outflow is an important issue that should be taken into consideration when deciding the necessity for reconstruction of the middle hepatic vein.

Role of MDCT angiography in assessment of vascular variant in potential living liver donor transplantation

PurposeThis study intends to asses the impact of multiphase three-dimensional Multidetector Computed tomography (MDCT) angiography in facilitating patient selection and surgical planning in potential donors being evaluated for living adult right lobe liver transplantation. Patient and methodsFifty consecutive potential living liver donors who underwent three-dimensional (MDCT) angiography were included. MDCT angiography findings were compared with surgical results. ResultsThe overall impact of three-dimensional MDCT angiography in diagnosis of A. ConclusionMDCT angiography with multiplanar and three-dimensional techniques is a valuable tool for the evaluation of potential living liver donors that provides complete and comprehensive information on the hepatic vascular anatomy. It allows an optimal graft to be obtained that maintains the balance between blood supply and venous drainage.

Live liver donors: Are they at a higher risk for post-operative thrombotic complications?

Live liver donor transplantation to adult recipients is becoming a common practice, increasing the organ pool and providing an alternative to whole cadaveric liver transplantation. These patients are healthy adults without serious medical conditions and typically have normal coagulation profiles preoperatively. Right hepatic lobectomy is usually performed for adult recipients, while left hepatic lobectomy is performed for pediatric recipients. Removal of the whole right lobe from the donors may expose theses patients to multiple intraoperative and postoperative complications. Hypercoagulability has been identified as a serious complication which leads to thromboembolic phenomena with potential fatal consequences. The primary aim of this review is to look at possible changes in post-operative coagulation dynamics that may increase the risk for development of thromboembolic complications in live liver donors. In this article, we stress the importance of addressing the issue that conventional clotting tests (PT, INR, PTT) are unable to detect a hypercoagulable state, and therefore, we should examining alternative laboratory tests to improve diagnosis and early detection of thrombotic complications. Measurement of natural anticoagulant/procoagulant biomarkers combined with conventional coagulation studies and thromboelastography offers a more accurate assessment of coagulation disorders. This allows earlier diagnosis, permitting appropriate intervention sooner, hence avoiding potential morbidity and mortality. Biomarkers that may be evaluated include, but are not limited to: protein C, soluble P-selectin, antithrombin III, thrombin-antithrombin complex, and thrombin generation complex.

Perioperative nursing coordination in adult living liver donor transplantation donor cut and recipient operation

Objective To summarize the key points, the main points of perioperative nursing coordination in 31 cases of adult living donor liver transplantation donor cut and recipient operation. Methods 34 cases of adult living donor liver transplantation donor and recipient operation cut perioperative nursing were retrospectively analyzed and summarized, which were collected in our hospital from June 2006 to February 2008. Main contents of preoperational preparations, operation cooperation and intraoperative care were summarized. Results 34 cases of liver surgery and 31 cases of cut receptors were successful, and no complications were occurred. Mean operative time was 5.5 h in cut donor, and blood loss was 341 ml, of which 2 cases of donor treated with blood transfusion. Mean operative time 10. 8 h in receptor, blood loss 1 100 ml. Conclusions Professional, standard, skilled perioperative nursing are key points in liver transplant operation and can help reduce blood loss, operative time and prevent intraoperative complications. Key words: Liver uansplantation; Perioperative nursing; Living donors; Recipient operation

A New Systematic Classification of Peripheral Anatomy of the Right Hepatic Duct: Experience From Adult Live Liver Donor Transplantation

Objective The peripheral intrahepatic biliary anatomy, especially at the sectorial level on the right side, has not been adequately described. The purpose of our study was to systematically describe this complex anatomy in clinically applicable fashion. Patients and Methods We analyzed three-dimensional computed tomography (CT) imaging reconstructions of 139 potential living liver donors evaluated at our institution between January 2003 and June 2007. Results Eighty-nine (64%) donors had a normal right bile duct sectorial anatomy. In the other 50/139 (36%) cases, we observed abnormal sectorial branching patterns, with 45/50 abnormalities as trifurcations, whereas the remaining ones were quadrifurcations. In 22/50 (44%) abnormalities, a linear branching pattern (types B1/C1) and an early segmental origin off the right hepatic duct (types B3/C3) were present, a finding of particular danger when performing a right graft hepatectomy. In 2 cases, we noted a mixed type (B6/C6) of a rare complex anatomy. Conclusions Our proposed classification of the right sectorial bile duct system clearly displays the “area at risk” encountered when performing right graft adult live donor liver transplantation and tumor resections involving the right lobe of the liver.

Hepatic Hilar and Sectorial Vascular and Biliary Anatomy in Right Graft Adult Live Liver Donor Transplantation

Introduction The aim of this study was to analyze vascular and biliary variants at the hilar and sectorial level in right graft adult living donor liver transplantation. Methods From January 2003 to June 2007, 139 consecutive live liver donors underwent three-dimensional computed tomography (3-D CT) reconstructions and virtual 3-D liver partitioning. We evaluated the portal (PV), arterial (HA), and biliary (BD) anatomy. Results The hilar and sectorial biliary/vascular anatomy was predominantly normal (70%–85% and 67%–78%, respectively). BD and HA showed an equal incidence (30%) of hilar anomalies. BD and PV had a nearly identical incidence of sectorial abnormalities (64.7% and 66.2%, respectively). The most frequent “single” anomaly was seen centrally in HA (21%) and distally in BD (18%). A “double” anomaly involved BD/HA (7.2%) in the hilum, and HA/PV and BD/PV (6.5% each) sectorially. A “triple” anomaly involving all systems was found at the hilum in 1.4% of cases, and at the sectorial level in 9.4% of instances. Simultanous central and distal abnormalities were rare. In this study, 13.7% of all donor candidates showed normal hilar and sectorial anatomy involving all 3 systems. A simultaneous central and distal “triple” abnormality was not encountered. A combination of “triple” hilar anomaly with “triple” sectorial normality was observed in 2 cases (1.4%). A central “triple” normality associated with a distal “triple” abnormality occurred in 7 livers (5%). Conclusions Our data showed a variety of “horizontal” (hilar or sectorial) and “vertical” (hilar and sectorial) vascular and biliary branching patterns, providing comprehensive assistance for surgical decision-making prior to right graft hepatectomy.

Estimation of standard liver volume in Japanese living liver donors

Standard liver volume (SLV) is an important concept in adult living liver donor transplantation. The purpose of this study was to re-evaluate and modify the authors' previous formula for predicting total liver volume (TLV). The TLV of 301 Japanese living donors was measured by computed tomography. This TLV was then compared with the liver volume calculated using established formulas. The correlation between TLV and several factors including body surface area (BSA) were analyzed and a new equation (SLVn) to better approximate TLV was determined. Factors related to the difference between TLV and SLVn were examined. Average TLV was 1196.3 +/- 221.0 cm3. Urata's formula underestimated TLV by 17.6 cm3 and the other formulas overestimated it by 120.4-244.9 cm3. TLV could be approximated by BSA; SLVn (cm3) = -404.8 + 961.3 x BSA (m2, R2 = 0.58). SLVn tended to overestimate the TLV of older donors and to underestimate TLV of thin donors. A new simple formula is presented that might be a better fit for calculating TLV in Japanese adults. This formula might be useful for evaluating the size of an adequate graft.