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      Preoperative CT evaluation of potential donors in living donor liver transplantation

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          Abstract

          Living donor liver transplantation is an effective, life sustaining surgical treatment in patients with end-stage liver disease and a successful liver transplant requires a close working relationship between the radiologist and the transplant surgeon. There is extreme variability in hepatic vascular anatomy; therefore, preoperative imaging of potential liver donors is crucial not only in donor selection but also helps the surgeons in planning their surgical approach. In this article, we elaborate important aspects in evaluation of potential liver donors on multi-detector computed tomography (MDCT) and the utility of MDCT in presurgical assessment of the hepatic parenchyma, relevant hepatic vascular anatomy and segmental liver volumes.

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          Most cited references 27

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          Liver regeneration.

          Liver regeneration after partial hepatectomy is a very complex and well-orchestrated phenomenon. It is carried out by the participation of all mature liver cell types. The process is associated with signaling cascades involving growth factors, cytokines, matrix remodeling, and several feedbacks of stimulation and inhibition of growth related signals. Liver manages to restore any lost mass and adjust its size to that of the organism, while at the same time providing full support for body homeostasis during the entire regenerative process. In situations when hepatocytes or biliary cells are blocked from regeneration, these cell types can function as facultative stem cells for each other.
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            Macrovesicular hepatic steatosis in living related liver donors: correlation between CT and histologic findings.

            To assess degree of macrovesicular steatosis with unenhanced computed tomography (CT) and correlate it with histologic findings in potential donors for living related liver transplantation. Forty-two candidates underwent unenhanced CT within 4 weeks of core liver biopsy. An experienced liver pathologist, blinded to both CT and surgical findings, retrospectively reviewed biopsy specimens and determined degree of macrovesicular steatosis. A radiologist blinded to histologic grading calculated mean hepatic attenuation in each donor liver by averaging 25 region-of-interest (ROI) measurements on five sections (five ROIs per section). Mean splenic attenuation was calculated with three separate ROI measurements. Liver attenuation index (LAI) was derived and defined as the difference between mean hepatic and mean splenic attenuation. Body mass index (BMI) was determined for each patient. Linear regression analysis was used to correlate degree of macrovesicular steatosis with both LAI and BMI. LAI correctly predicted degree of macrovesicular steatosis in 38 (90%) of 42 cases. In four of four livers, LAI below -10 HU correlated with greater than 30% macrovesicular steatosis (unacceptable for liver transplantation). In nine of 11 livers, LAI was between -10 and 5 HU and correctly predicted 6%-30% steatosis (relative contraindication). In two of 11 cases, LAI overestimated degree of hepatic steatosis. LAI above 5 HU correctly predicted 0%-5% steatosis in 25 of 27 livers. In two of 27 cases, parenchymal hemosiderin deposition led to an increase in LAI into the normal range, despite mild histologically confirmed steatosis. Degree of histologic macrovesicular steatosis correlated well with LAI (r = 0.92) and marginally with BMI (r = 0.45). Of 27 potential donors with normal livers at CT and acceptable LAI levels, four (15%) were deemed poor donor candidates because core biopsy revealed subtle hepatic necrosis and nonspecific hepatitis. Although unenhanced CT quantifies the degree of macrovesicular steatosis relatively well, it may preclude a liver biopsy only in a small percentage of potential donors with low LAI (unacceptable degree of steatosis). Core liver biopsy is still necessary in the majority of donors with normal LAI to identify those with both fatty liver and coexistent hemosiderin deposition or radiologically occult diffuse liver diseases. Copyright RSNA, 2004
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              Automated hepatic volumetry for living related liver transplantation at multisection CT.

              To prospectively compare in vivo hepatic automated volumetry with manual volumetry and measured liver volume. The study was conducted in accordance with the guidelines of the Institutional Review Board of Kumamoto University (Japan). Patient informed consent was obtained. Preoperative multisection computed tomography (CT) was performed in 35 consecutive patients (21 men, 14 women; mean age, 42.8 years; range, 28-72 years) with hepatic disease awaiting living related liver transplantation. The CT scans covered the entire liver at a section thickness of 2.5 mm. Liver volume was estimated by using both the automated and the manual methods. Actual liver weight was obtained for all patients and was converted to hepatic volume on the basis of a predetermined relationship between actual liver weight and volume. Processing time required for both methods was also recorded. Two-tailed paired t test, correlation coefficient, and Bland-Altman tests were used for statistical analyses. Mean liver weight was 881.7 g +/- 249.8 (standard deviation), and mean measured liver volume was 956.00 cm(3) +/- 280.10. Volumetry performed with the automated and manual methods provided liver volumes of 982.99 cm(3) +/- 301.98 and 937.10 cm(3) +/- 301.31, respectively. There was good correlation between measured and estimated volumes obtained with the automated method (r = 0.792, P < .01). The manual and automated methods required 32.8 minutes +/- 6.9 and 4.4 minutes +/- 1.9, respectively. The automated method reduced the time required for volumetry of the liver and provided acceptable measurements. (c) RSNA, 2006.
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                Author and article information

                Journal
                Indian J Radiol Imaging
                Indian J Radiol Imaging
                IJRI
                The Indian Journal of Radiology & Imaging
                Medknow Publications & Media Pvt Ltd (India )
                0971-3026
                1998-3808
                Oct-Dec 2014
                : 24
                : 4
                : 350-359
                Affiliations
                [1]Department of Radiology, Center for Liver and Biliary Sciences, Indraprastha Apollo Hospital, New Delhi, India
                [1 ]Departments of Surgical Gastroenterology and Liver Transplant, Center for Liver and Biliary Sciences, Indraprastha Apollo Hospital, New Delhi, India
                [2 ]Departments of Surgical Gastroenterology and Liver Transplant, Center for Liver and Biliary Sciences, Indraprastha Apollo Hospital, New Delhi, India
                Author notes
                Correspondence: Dr. Sandeep Vohra, Department of Radiology, Indraprastha Apollo Hospital, Sarita Vihar, Delhi Mathura Road, New Delhi - 110 076, India. E-mail: savohra@ 123456yahoo.com
                Article
                IJRI-24-350
                10.4103/0971-3026.143897
                4247504
                25489128
                7c4cc924-2266-4958-9573-b9ba8dd158c6
                Copyright: © Indian Journal of Radiology and Imaging

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Transplant Imaging

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