Holger Bourquain MD, Presenter: Nothing to Disclose

Milo Hindennach, Abstract Co-Author: Nothing to Disclose

Christoph Wald MD, PhD, Abstract Co-Author: Nothing to Disclose

Yasuhiro Fujimoto MD, Abstract Co-Author: Nothing to Disclose

Elizabeth A Pomfret MD, Abstract Co-Author: Nothing to Disclose

Koichi Tanaka MD, Abstract Co-Author: Nothing to Disclose

Heinz Otto Peitgen PhD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

In planning of adult to adult living donor liver transplantation (ALDLT) it is crucial to ensure a sufficient functional liver volume for both, the recipient and the donor. Standard CT image analysis allows for the calculation of the graft and remnant volumes only, not taking into account impaired liver function due to hepatic venous congestion. The aim of the study was to calculate the territories at risk of venous congestion for interactively defined resections and compare the results with the intra-operative findings.

Over a period of 17 months (12/2002 – 04/2004) 187 consecutive potential donors for ALDLT from 12 hospitals worldwide have been evaluated with the software assistants HepaVision2 and InterventionPlanner in the research project „SIMPL“. In this abstract we focus on 101 potential donors from 2 hospitals (64 Japan, 37 US). In all donors a resection to the right of the middle hepatic vein (MHV) was planned and the hepatic venous drainage territories of the so defined right lobe grafts were calculated. Resection planning was performed based on patient-individual 3D reconstructions.

The median calculated graft volumes of the right lobe grafts for the two hospitals were 758 ml (Standard Deviation (SD) 154 ml, 455-1161 ml) and 1009 ml (SD 268 ml, 651-1989 ml) respectively. The median relative graft volumes were 64% (SD 4.9%) and 61% (SD 5.8%). The difference of the median relative graft volumes is not statistically significant (p=0.05). Of the right lobe grafts 25% (SD 9.6%) and 23 % (SD 9.4%) respectively are drained via the middle hepatic venous branches and are therefore at risk of venous congestion. Visual comparison of the predicted congested volumes with the intra-operative findings showed a good correlation.

Estimation of the functional graft volume or remnant volume is possible based on standard CT examinations, thus allowing a better planning of the procedure and therefore minimizing the risk of insufficient volumes in both donor and recipient. About one forth of the right lobe graft volume is drained via middle hepatic venous branches and is therefore at risk of venous congestion. This was true for both populations investigated in this study.

Bourquain, H, Hindennach, M, Wald, C, Fujimoto, Y, Pomfret, E, Tanaka, K, Peitgen, H, et al, , Risk Analysis in Adult to Adult Living Donor Liver Transplantation by Combining Patient Individual Vascular Territories with Interactively Defined Resection Proposals.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4412877.html