Graft Selection Algorithm Based on Congestion Volume for Adult Living Donor Liver Transplantation

Authors: Asakuma, M.; Fujimoto, Y.; Bourquain, H.¹; Uryuhara, K.²; Hayashi, M.³; Tanigawa, N.³; Peitgen, H.-O.¹; Tanaka, K.²

Source: American Journal of Transplantation, Volume 7, Number 7, July 2007 , pp. 1788-1796(9)

Publisher: Wiley-Blackwell

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Abstract:

A major concern in adult-to-adult living donor liver transplantation is the selection of graft type; that is, is it is better to use the right lobe with or without the middle hepatic vein (MHV)? This choice has a considerable impact on donor safety, vascular reconstruction and graft function in the recipient. To facilitate making an appropriate choice, on the basis of a preliminary study (n = 17), we herein propose a graft selection algorithm using three parameters: graft-to-recipient body weight ratio (GRWR), percentage remnant liver volume (%RLV) and estimated congestion ratio (ECR). The algorithm was evaluated with 50 consecutive cases with respect to postoperative liver function of donors and recipients and survival of recipients. Postoperative recovery was comparable between the two groups (p = NS). The overall cumulative 18-month survival rate was 86.7% for the `with MHV graft group', and 76.1% for the gwithout MHV graft grouph (p = NS). For 41 cases (82%), graft types were chosen according to the algorithm, whereas the remaining 9 cases (18%) needed detailed discussion of donor, recipient and operative factors. In conclusion, we constructed a graft selection algorithm based on congestion volume, which will contribute to objective graft-type selection in adult-to-adult LDLT.

Keywords: Donor safety; graft selection; hepatic venous congestion; liver transplantation; living donor; right lobe graft; Abbreviations; ECR; estimated congestion ratio; GRWR; graft-to-recipient body weight ratio; LDLT; living donor liver transplantation; MHV; middle hepatic vein; RLV; remnant liver volume

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1600-6143.2007.01849.x

Affiliations: 1: MeVis- gGmbH, Center for Medical Diagnostics and Visualization, Bremen, Germany 2: Department of Transplantation and Immunology, Kyoto University Faculty of Medicine, Kyoto, Japan 3: Department of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan

Publication date: 2007-07-01

Graft Selection Algorithm Based on Congestion Volume for Adult Living Donor Liver Transplantation

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