The Clinical Study Of Preoperative Evaluation And Precise Hepatic Parenchymal Transection Of Adult Living Donor Liver Transplantation

PURPOSE Comprehensive and correct preoperative evaluation is one of the important part for the living donor liver transplantation,which is the indispensable process for the safety of the potential donor.The purpose of this study is to build a safety,correct and high efficiency selection protocol for the potential donor and to discuss the conception and technique of the precise hepatic parenchymal transection.METHODS A prospective study was performed on 35 consecutive liver donors who underwent right hepatectomy for 32 liver receptors in the general hospital of PLA from July 2006 to May 2008.Hepatic mass,steatosis and the variant anatomy of hepatic artery,vein and biliary tract were carefully studied with CT/MRI.The individual operative protocol was determined according to the result of preoperative evaluation and the precise hepatic parenchymal transaction technique was performed during the operation.The total 32cases of adult to adult living donor liver transplantation(LDLT)include dual-graft liver transplantation 3 cases and auxiliary partial orthotopic liver transplantation using left lobe 1 case.The 35 cases of liver donor constitute of 30 cases of right hepatic donors(26 cases with the middle hepatic vein(MHV)and 4 cases without MHV),3 cases of left hepatic donors(2 cases with MHV and 1 cases without MHV)and 2 case of left lateral lobe.RESULT The preoperative imaged evaluation revealed various anatomy variant including 9 cases of anomalous hepatic artery anatomy(9/35),2 cases of the right portal vein(2/42),4 cases right bile duct(4/35)and 4 cases of hepatic steatosis, which all verified by biopsy or operation.The excellent relationship between the stimated hepatic mass using CT/MRI and the weight of hepatic lobe resected inoperation was reached.The CT different density between liver and spleen was less than 5 HU,the CT ratio less than 1.1,BMI≥28Kg/m~2 and the decrease of MRI out phase are reach the approving sensitivity and specificity for the diagnosis of from mild to moderate hepatic steatosis.The "all-in-one" image evaluation could be completed by enhanced MRI,which has the capable of measuring the hepatic mass,hepatic steatosis,and displaying the anatomy variant of hepatc vessels,especially for bile duct.Postoperative complications occurred in 6 times/cases,in which 1 case required surgical intervention.All donors are well leaved hospital without any long-term complications.CONCLUSIONS The preoperative evaluation using CT/MRI,especially the all-in-one enhanced MRI,is an utility tool for evaluating the donor's hepatic quality,mass and the various anatomical variant of hepatic vessels.The conception and techniques of precise hepatic transection has undoubted role for the safety of the donors.