Living-related Donor Liver Research Articles

Non-Contrast-Enhanced MR Arteriography of Potential Living-Related Liver Donor: Using Contrast Enhanced CT Arteriography as Standard Reference.

Contrast-enhanced computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are the primary modalities to assess donors' vessels before transplant surgery. Radiation and contrast medium are potentially harmful to donors. To compare the image quality and visualization scores of hepatic arteries on CTA and balanced steady-state free-precession (bSSFP) non-contrast-enhanced MRA (NC-MRA), and to evaluate if bSSFP NC-MRA can potentially be a substitute for CTA. Prospective. Fifty-six consecutive potential living-related liver donors (30.9 ± 8.4 years; 31 men). 1.5T; four bSSFP NC-MRA sequences: respiratory-triggered (Inhance inflow inversion recovery [IFIR]) and three breath-hold (BH); and CTA. The artery-to-liver contrast (Ca-l) was quantified. Three radiologists independently assigned visualization scores using a four-point scale to potential origins, segments, and branches of the hepatic arteries, determined the anatomical variants based on Hiatt's classification, and assessed the image quality of NC-MRA sequences. Fleiss' kappa to evaluate the readers' agreement. Repeat measured ANOVA or Friedman test to compare Ca-l of each NC-MRA. Friedman test to compare overall image quality and visualization scores; post hoc analysis using Wilcoxon signed-rank test. P-value <0.05 was considered statistically significant. Inhance IFIR Ca-l was significantly higher than all BH bSSFP Ca-l (0.56 [0.45-0.64] vs. 0.37 [0.29-0.47] to 0.41 [0.23-0.51]). Overall image quality score of BH bSSFP TI1200 was significantly higher than other NC-MRA (4 [4-4] vs. 4 [3 to 4-4]). The median visualization scores of almost all arteries on CTA were significantly higher than on NC-MRA (4 [3 to 4-4] vs. 1 [1-2] to 4 [4-4]). The median visualization scores were all 4 [4-4 ] on Inhance IFIR with >92.3% observed scores ≥3, except the segment 4 branch (3 [1-4], 53.6%). The identification rates of arterial variants were 92.9%-97% on Inhance IFIR. Although CTA is superior to the NC-MRA, all NC-MRA depict the donor arterial anatomy well. Inhance IFIR can potentially be an alternative image modality for CTA to evaluate the arterial variants of living donors. 3 TECHNICAL EFFICACY: Stage 2.

Predictors of Sarcopenia in an Obese Asian Population

Sarcopenia is associated with obesity and might also be responsible for other disorders. Here, we investigated the prevalence of sarcopenia and its predictors in obese subjects. Subjects who underwent a medical health checkup and living-related liver donors were recruited. Obesity was defined as body mass index (BMI) ≥25 kg/m2. Muscle mass was assessed using computed tomography at the 3rd lumbar vertebra. The lowest quartile of the lumbar skeletal muscle index (LSMI) was considered sarcopenia. Among 466 obese subjects, 53 (11.4%) had sarcopenia. Subjects with sarcopenia were significantly older (mean 66.6 vs. 53.3 years) and had a significantly higher prevalence of hypertension (62.3 vs. 46.0%) and diabetes (45.3 vs. 31.0%), higher fibrosis-4 (FIB-4) index (mean 1.57 vs. 1.16), and higher atherosclerotic cardiovascular disease (ASCVD) risk score (mean 22.86% vs. 11.15%), whereas they had a significantly lower prevalence of female gender (13.2% vs. 27.8%), lower BMI (mean 26.4 vs. 27.4 kg/m2), and lower LSMI (mean 43 vs. 56 cm2/m2) than subjects without sarcopenia (all P < 0.05). On multivariate analysis, higher BMI (odd ratio [OR] = 0.599, P = 0.001) was independently associated with a reduced risk of sarcopenia, whereas higher ASCVD risk scores (OR = 1.045, P < 0.001) were independently associated with an increased risk of sarcopenia. Sarcopenia is significantly associated with lower BMI and higher cardiovascular risk in an obese Asian population.

Concentration of CD34/CD45 Positive Cells in Peripheral Blood of Pediatric Patients before and after Living Donor Liver Transplantation

Introduction: The number of bone marrow stem cells (BMSC) can increase in peripheral blood as a response to inflammation, tissue damage and different stress signals. It has been shown that host BMSC can be detected in transplanted liver. Probably the stem cells can influence the liver regeneration but the exact role of the cells is not clear yet. The aim of the study was to determine the relationship between concentration of CD34/CD45+ cells in peripheral blood and plasma level of biomarkers of inflammation and biochemical parameters following living donor liver transplantation (LDLT) and partial liver resection. Methods: The study included 15 pairs of recipients (aged from 4 to 60 months, 8 male/7 female) and adult living-related liver donors (29±5 years, 6 male/9 female). All pediatric patients had liver cirrhosis caused by congenital and inherited diseases of hepatobiliary system. The procedures in donors included left lateral sectorectomy, in recipients - hepatectomy, orthotopic implantation of left lateral sector, biliary reconstruction by hepaticojejunostomy. All recipients received 2- or 3-drug immunosuppressive therapy including tacrolimus. Concentration of CD34/CD45+ cells were measured by flow cytometry, plasma level of C-reactive protein (CRP) was determined by immunoturbidimetry, soluble ligand of CD40 (sCD40L), soluble CD30 (sCD30) and neopterin - by ELISA. Results: Before LDLT concentration of CD34/CD45+ cells in venous blood of pediatric patients was higher than in adult healthy donors. After LDLT number of CD34/CD45+ cells did not change in peripheral blood of liver recipients. Partial liver resection in donors did not cause significant changes in number of CD34/CD45+ cells in blood. Before LDLT in recipients CD34/CD45+ cells concentration did not correlate (Spearman's test) with sex, age, weight, height, sCD40L (co-stimulatory molecule of T-lymphocyte activation), sCD30 (a marker of T-helper cells 2 type activation), neopterin, routine biochemical parameters such as bilirubin, total protein, ALT, AST and GGT activity and white blood cells count but correlated (p< 0,05) with CRP (rs=-0,69), albumin (rs=0,64), hemoglobin (rs=0,70) levels and red blood cells count (RBC) (rs=0,73). Conclusion: Presented data suggests that neither LDLT in children nor liver resection in healthy adult donors has significant influence on number of CD34/CD45+ cells in peripheral blood but the stem cells concentration has relationship with inflammatory activity, concentration of albumin, hemoglobin and RBC.

USE OF MR CHOLANGIOGRAPHY IN LIVING-RELATED LIVER DONORS — COMPARISON WITH INTRAOPERATIVE CHOLANGIOGRAPHY

Magnetic resonance (MR) imaging plays an important role in the preoperative evaluation of the living-related liver donors to reduce postoperative morbidity and complications. Though invasive, intraoperative cholangiography is still the golden standard in demonstrating anatomical variation of bile ducts. We design this study to compare the validity and reliability between these two imaging modalities and retrospectively searched the database of living-related liver transplantation (LRLT) center during the period from April 2005 to September 2008. The clinical information and images of total 58 donors (female : male = 35 : 23) were reviewed. Five types of branching patterns of the bile ducts were encountered. The rate of disagreement in the classification of branching pattern between MR and intraoperative cholangiography was 5% (3/58). Intraoperative cholangiography could detect significantly more division degree of right hepatic ducts (mean degree: 7) than MR cholangiography (mean degree: 4) (using paired t-test, p &lt; 0.05). No significant difference existed in the detection of division degree of left hepatic ducts. However, MR cholangiography was significantly better than intraoperative cholangiography in demonstrating major branches of the left hepatic ducts including tributaries of segment 2 and 3 (58/58 versus 35/58) (using McNemar's chi-square test, p &lt; 0.05). We conclude that MR cholangiography is nearly as good as intraoperative cholangiography in identifying the branching pattern of bile ducts, and demonstrates the major left hepatic ducts better.

Liver Regeneration in 120 Consecutive Living-Related Liver Donors

Background Living-related liver transplantation for pediatric patients has become an acceptable, low-risk treatment option. The aim of this study was to assess the extent of donor liver regeneration. Materials and Methods Between October 1999 and January 2008, 120 living-related donors provided 109 grafts consisting of segments II and III and 11 grafts consisting of segments II, III, and IV. Volumetric assessment of the donor liver and selected segments was performed using computed tomography. After procurement every graft was weighed. At 7 and 30 days, as well as 12 months after the operation the donor liver remnant was evaluated for differences in volume. Results A significant correlation was observed between the liver graft mass and its volume as assessed by computed tomography ( r = 0.781; P < .05). Twelve months after procurement, the average regeneration index was significantly higher among donors of segments II, III, and IV (144 ± 23%) versus donors of segments II and III (114 ± 15%; P < .05). Conclusion Liver regeneration after procurement of selected liver segments from living donors is a consistent finding. Computed tomography is an accurate imaging modality to track changes in liver volume. This study showed a positive correlation between the size of the liver graft and the regeneration of the liver remnant in the donor.

Living-related donors' quest for information before donation

Providing potential living-related liver donors with all the necessary information before donation can be challenging. What information donors need and are not getting during the evaluation phase has not been defined. To increase understanding of the everyday life of living-related liver donors and to suggest educational strategies that could be used by transplant centers during the evaluation process. An interpretive ethnographic study based on a symbolic interactionism approach. All participants were interviewed; some were reinterviewed in order to better understand their experience as a donor. Interviews took place in the clinic, the donor's home, the donor's workplace, and in coffee shops depending on each donor's preference. A total of 13 parents who had donated the left lower lobe of their liver to their son or daughter at least 1 year ago. Interviews were analyzed by using qualitative research methods of coding, summarizing, and discussing concepts. The donors viewed the donation as a life-changing event, and 11 of 13 donors described seeking further information in addition to the information given to them by the transplant center. Searching the Internet, reading research articles, and speaking to other donors were activities demonstrated by the participants.

Living-Related Donors' Quest for Information before Donation

Providing potential living-related liver donors with all the necessary information before donation can be challenging. What information donors need and are not getting during the evaluation phase has not been defined. To increase understanding of the everyday life of living-related liver donors and to suggest educational strategies that could be used by transplant centers during the evaluation process. An interpretive ethnographic study based on a symbolic interactionism approach. All participants were interviewed; some were reinterviewed in order to better understand their experience as a donor. Interviews took place in the clinic, the donor's home, the donor's workplace, and in coffee shops depending on each donor's preference. A total of 13 parents who had donated the left lower lobe of their liver to their son or daughter at least 1 year ago. Interviews were analyzed by using qualitative research methods of coding, summarizing, and discussing concepts. The donors viewed the donation as a life-changing event, and 11 of 13 donors described seeking further information in addition to the information given to them by the transplant center. Searching the Internet, reading research articles, and speaking to other donors were activities demonstrated by the participants.

Study on visualized virtual surgery of living-related donor liver transplantation

To investigate the significance of three dimensional visualization and virtual surgery system in living related donor liver transplantation surgery. Two patients suffered biliary calculi were scanned by 64 slice helical computer tomography (CT) on livers and the data were imported into medical image proceeding system (MIPS) for sequence. Man-made segmentation and true-up on the image from the data were carried out. Three dimensional (3D) models of the liver and the intrahepatic vessels were reconstructed by VTK software respectively. The models were exported with format STL from it and then were imported into the FreeForm Modeling System for smoothing and modifying. At last, living related donor liver transplantation were simulated with the force-feedback equipment (PHANToM). It had great verisimilar image for the reconstructed 3D liver models with artery, hepatic vein, portal vein and bile duct. By seeing through liver, it had high fidelity and strong 3D effect for the intrahepatic artery, hepatic vein, portal vein and bile duct, and their spatial disposition and course and co-relationship were shown clearly. In the virtual surgery system, the virtual scalpel could be manipulated on 3D liver model with PHANToM. The simulating effect was the same as the clinic operation for living related donor liver transplantation. The visualized liver model reconstructed is 3D and verisimilar, and it is helpful to design reasonable scheme for liver transplantation. It can improve the surgical effect, decrease the surgical risk, reduce the complication, enhance the communication between doctor and patient through designing surgical plan and demonstrating visualized operation before surgery.

Value of an individual liver biopsy in the preoperative evaluation of apparently healthy potential liver donors

Living donor liver transplantation has acquired widespread acceptance. A thorough workup of the potential living donor is guided by 2 objectives: the first is ensuring the safety of the surgical procedure for the donor, and the second is identifying donor grafts that pose potential risks for the recipient. Of 305 living-related liver donors, liver biopsy was performed in 201. The results of those patients' liver function tests and serologic tests were within normal limits. Forty-one of the 201 patients had steatosis on abdominal ultrasonography or tomography. Of 201 liver biopsies, 94 (46.8%) demonstrated normal findings, whereas 107 (53.2%) showed abnormal findings on pathology. Of 107 patients with abnormal pathological findings, 32 (29.9%) had fatty changes, 4 (3.7%) had steatohepatitis, and 71 (66.4%) had nonsteatotic histologic findings including fibrosis, hepatitis, and granulomatous reactions. In conclusion, our data show that half of the living-related liver donors, appearing absolutely healthy, had biopsies with abnormal pathology results. As it is well known that increasing percentages of steatosis may reduce the functional mass of the graft and occult liver diseases may not be detected without liver biopsy, we recommend that liver biopsies be part of the routine evaluation protocol for living-related liver donors in all transplantation institutions.

Postsurgical Complications in Living-Related Liver Donors

From September 2001 until March 2007, we performed 127 living-donor liver transplantations in our transplantation center. Of 127 donors, 74 were men and 53 women, of overall mean donor age of 35.2 ± 9.3 years (range, 20–56 years). Ninetysix (75.6%) were first-degree relatives, 18 (14.1%) were second-degree relatives, and 13 (10.3%) were spouses. We performed 34 (26.7%) left hepatic lobectomies, 33 (25.3%) left lateral segmentectomies, and 60 (48%) right hepatic lobectomies. The mean percentages of remnant to donor total liver volume for the right, left, and left-lateral lobectomies were 41.7%, 67.8%, and 75.1%, respectively. The mean length of patient postoperative hospital stay was 7.4 ± 3.1 days (range, 3–33 days). There was no postoperative mortality. Ten complications occurred in 7 of the 127 donors (5.5%). Most complications were treated with radiologic interventions. In conclusion, donor safety should be the primary focus in living-donor liver transplantation. More experience, improved surgical techniques, and meticulous donor evaluation will help to minimize morbidity and mortality for living liver donors.

Evaluation of Donor’s Liver Regeneration After Left Lobe Harvesting for Living-Related Liver Transplantation

Background Computerized tomography–assisted volumetry permits one to estimate the volume of the liver graft as well as to monitor the regeneration in the donor for living- related liver transplantation (LRLT). Methods The size of the whole liver and of the segments II, III, and IV was assessed in 64 living-related liver donors by preoperative computerized tomography (CT) volumetry. Segments II and III were harvested in 56 cases; segments II, III, and IV in 8 cases. The remnant liver was assessed by CT volumetry on postoperative days 7 and 30. Results There was a linear correlation between the calculated volume of the graft and its weight (R = 0.61, P < .04). Postoperative CT volumetry of the liver from a living-related donor showed a different pattern of volume restoration (regeneration index) both at 7 and 30 days among donors who sacrificed segments II and III versus segments II, III, and IV. The mean regeneration indices were significantly higher among donors of segments II, III, and IV compared with donors of segments II and III after 7 and 30 days ( P < .05). Discussion It is possible that the donor liver displays a different pattern of growth due to the alteration in the blood supply to segment IV.

Changes in apparent systemic clearance of propofol during transplantation of living related donor liver

Propofol is used during living-related donor liver transplantation because its metabolism is not greatly affected by liver failure. However, the pharmacokinetics of propofol during liver transplantation have not been fully defined. The purpose of this study was to evaluate the apparent systemic clearance of propofol during the dissection, anhepatic and reperfusion phases of living-related donor liver transplantation, and to estimate the role of the small intestine and lung as extrahepatic sites for propofol disposition. Ten patients scheduled for living-related donor liver transplantation were enrolled in the study. Anaesthesia was induced with vecuronium 0.1 mg kg(-1) and propofol 2 mg kg(-1), and then maintained by 60% air, 0.5-1.5% isoflurane in oxygen and a constant infusion of propofol at 2 mg kg(-1) h(-1). Apparent systemic clearance during the dissection, anhepatic and reperfusion phases was calculated from the pseudo-steady-state concentration for each phase. Disposition in the small intestine was determined by measuring arteriovenous blood concentration in 10 liver transplantation donors. Pulmonary disposition was determined by measuring the arteriovenous blood concentration in 10 recipients during the anhepatic phase. The data are expressed as mean (sd). Apparent systemic clearances in the dissection, anhepatic and reperfusion phases were 1.89 (sd 0.48) litre min(-1), 1.08 (0.25) litre min(-1) and 1.53 (0.51) litre min(-1), respectively. The concentration of propofol in the portal vein was lower than in the radial artery. The intestinal extraction ratio calculated from the concentration in the radial artery and portal vein was 0.24 (0.12). There were no significant differences in propofol concentrations between the radial and pulmonary arteries. Apparent systemic clearance was decreased by approximately 42 (10)% during the anhepatic phase compared with the dissection phase. After reperfusion, liver allografts rapidly began to metabolize propofol. The small intestine also participates in the metabolism of propofol.

Initial hepatic microcirculation correlates with early graft function in human orthotopic liver transplantation

Microcirculatory disturbances are an initial causative determinant in hepatic ischemia/reperfusion injury. The aim of this study was to assess sinusoidal perfusion during human liver transplantation using orthogonal polarization spectral imaging and to evaluate the significance of intraoperative microcirculation for early postoperative graft function. Hepatic microcirculation was measured in 27 recipients undergoing full-size liver transplantation and compared to a group of 32 healthy living-related liver donors. The microvascular parameters were correlated with postoperative aspartate aminotransferase and bilirubin levels. Hepatic perfusion following liver transplantation was found to be significantly decreased when compared with the control group. Volumetric blood flow within the individual sinusoids increased due to sinusoidal dilatation and enhanced flow velocity. Regression analysis of postoperative aspartate aminotransferase and bilirubin with microvascular parameters revealed significant correlations. The extent of volumetric blood flow increased within the first 30 minutes after reperfusion and showed a significant correlation with postoperative aspartate aminotransferase release and bilirubin elimination. In conclusion, postischemic hepatic microvascular perfusion was analyzed in vivo, demonstrating significant microvascular impairment during liver transplantation. Sinusoidal hyperperfusion appears to confer protection against postischemic liver injury, as given by the correlation with aspartate aminotransferase and bilirubin levels. Thus, these findings may have therapeutic importance with respect to mechanisms mediating postischemic reactive hyperemia.

Analysis of postsurgical complications in 65 living-related liver donors

Analysis of postsurgical complications in 65 living-related liver donors

Effect of ethanolamine on liver regeneration after 90% hepatectomy in rats

SURGICAL PROCEDURES, such as extended liver resection or living-related liver transplantation may be performed because normal liver has vigorous regenerative potential. However, reduced hepatic volume can produce postoperative hepatic insufficiency, which is a serious problem. After extensive liver resection for hepatic tumor or in living-related liver donors maximum volume of liver resection or thus the minimum volume of donor liver are limited. When the volume exceeds these limits, surgical treatment is not indicated. However, a new treatment that promotes postoperative liver regeneration would extend these limits. Two approaches have been attempted to promote liver regeneration. One approach prepares the host environment for liver regeneration by plasma exchange. In recent years, favorable results also have been reported using a bioartificial liver as a bridge. The other approach is promotion of liver regeneration using hepatocyte growth factor (HGF) or ethanolamine (EA). EA is a nutrient factor derived from the small intestine. In this study, we investigated the enhancing effect of EA using a 90% partial hepatectomy (PHX) rat model.

Long-Term Follow-Up of Living-Related Partial Liver Donors

Long-Term Follow-Up of Living-Related Partial Liver Donors

Liver Transplantation in Infants Younger than 1 Year of Age

The authors report on experience with liver transplantation for infants younger than 1 year of age. Over the last 15 years, orthotopic liver transplant has become the only lifesaving procedure available for infants with end-stage liver disease. Many transplant centers initially required infants to reach a specific weight or age to minimize morbidity and mortality. Size-appropriate infant donors also were uncommon. As a result, many children, in the first few years of life, died of their disease. The availability of reduced-size cadaveric and living-related liver transplants has offered the ability to transplant the young infant with liver failure. The authors instituted a program to aggressively transplant infants with liver failure in the first year of life using both cadaveric and living-related liver donors. Between June 1991 and January 1995, 13 infants were transplanted for rapidly progressive liver failure. Infant age ranged from 4 to 11 months (mean, 7.5 months). The cause of liver failure included biliary atresia (11), alpha 1-antitrypsin deficiency (1), and liver failure secondary to echovirus 7 (1). The United Network for Organ Sharing status at the time of transplant ranged from status 4, intensive care unit bound (4 patients); status 3, hospitalized (4 patients); or status 2, failing at home (5 patients). Six patients (46%) received cadaveric whole organ (2) or segmental transplants (4). Seven patients (54%) received left lateral segment living-related transplants from parental donors. After operation, patients received cyclosporine or FK506-based immunosuppression. Three patients (23%) required four retransplants (two cadaveric for primary nonfunction; one living-related for graft thrombosis in the face of fungal infection and bile leak). Postoperative complications included primary nonfunction (15%), rejection (85%), graft vascular thrombosis (15%, two of three revascularized successfully), bacterial and fungal infections (77%), and viral infections (46%). Epstein-Barr virus-associated lymphoproliferative developed in two patients (15%). Intestinal perforation requiring reoperation developed in two patients (15%). Bile leaks requiring reoperation or transhepatic stinting or both developed in three patients (23%). Two patients died in the perioperative period (< 1 month) from a combination of primary nonfunction or graft thrombosis and sepsis. Overall survival was 85%, ranging from 11.0 months to 4.5 years. Orthotopic liver transplantation in infants younger than 1 year of age poses significant challenges from technical and infectious complications. Despite these barriers, overall patient survival is comparable to that of older children and adults.

Living related donor liver transplantation: Assessment of graft viability based on the redox theory. By K. Ozawa, 212 pp. Basel: Karger, 1994. $179.25

HepatologyVolume 20, Issue 6 p. 1647-1647 Book ReviewFree Access Living related donor liver transplantation: Assessment of graft viability based on the redox theory. By K. Ozawa, 212 pp. Basel: Karger, 1994. $179.25 Franklin M. Klion MD, Franklin M. Klion MD New York, New York 10028Search for more papers by this author Franklin M. Klion MD, Franklin M. Klion MD New York, New York 10028Search for more papers by this author First published: December 1994 https://doi.org/10.1002/hep.1840200645AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume20, Issue6December 1994Pages 1647-1647 RelatedInformation