In Situ Split Liver Transplantation for Two Adult Recipients: Possibility investigation by virtual measurement of liver volume

Kim, Young Soo; Hong, Bu Hwan; Choi, Sang Yong

Abstract

PURPOSE: In the last three decades liver transplantation (LT) has been established as a standard procedure for end-stage liver disease. However, the shortage of donor livers is the most significant factor inhibiting further application of clinical liver transplantation. In Korea, where B-hepatitis is endemic, most patients waiting for LT are adult with B-hepatitis associated end stage liver disease. Safe, in situ splitting of a cadaver donor liver for two separate adult recipients would be an attractive way to decrease the deaths of adult patients while waiting for organs. Split grafts weighing more than 1% of the recipient's body weight (Graft to Recipient Weight Ratio, GRWR>1%) should be transplanted in order to adequately meet postoperative metabolic needs. We investigated whether one cadaver liver can be split into two so that each graft has a GRWR>1%.
METHODS
Between January 1999 and December 1999 at Guro medical center, we selected 47 patients diagnosed as early gastric cancer (EGC) or early stage colon cancer and reviewed their pre-operative abdominal CT films for use in our study. Pictures of CT films were taken with a digital camera and converted to TIF files in order to calculate the standard liver volumes which were then divided by the plane that represented two operative methods proposed in this study. First, we performed a Rt. lobectomy along the right side of the middle hepatic vein to increase the function of segment IV by preventing venous congestion. Second, we performed a Lt. lobectomy with hepatic IVC to save the volume of the caudate lobe (segment I).
RESULTS
The body index of the 47 cases was distributed from -10% to 20%. The standard whole liver volume was 1266+/-299 ml (Mean+/-SD). Rt. lobe volume was 751+/-188 ml, and Lt. lobe volume was 515+/-154 ml. Each result was no less than 1% of 75 kg and 50 kg adult's body weight.
CONCLUSION
On average, the GRWR of the Rt. lobe is more than 1% in a 75 kg adult by itself and that of the Lt. lobe can also be above 1% in a 50 kg adult by maximizing the function of segments I and IV using the surgical techniques mentioned above. Therefore, we would be able to successfully spilt a cadaver donor liver to a 75 kg and a 50 kg adult recipient, respectively.