Cemile Ayşe GÖRMELİ, Bayram KAHRAMAN, Sezai YILMAZ, Zeynep Maraş ÖZDEMİR, Ayşegül Sağır KAHRAMAN

Canlı vericili karaciğer naklinde (CVKN) radyolojik değerlendirme: segment 4 arteri varyasyonlarının sol lob volümünün total karaciğer volümüne olan oranına etkisi

Amaç: Bu çalışmada amacımız canlı vericili karaciğer naklinde (CVKN) segment 4 arteri çıkış yeri varyasyonlarının sol lob ağılığı-total karaciğer ağırlığı oranı üzerine etkisinin olup olmadığını araştırmaktır. Gereç ve Yöntem: Toplam 136 verici adayının (70 erkek, 66 kadın) çok-fazlı BT görüntüleri elde edildi. Bireylerin ortalama yaşı 32,6±9 (19 ile 53 arasında) bulundu. Hepatik arterler, elde edilen ince kesit görüntülerin hacimsel gösterim teknikleri ile işlenmesi ile değerlendirildi ve segment 4 arteri çıkış yerleri not edildi. Tüm olgularda toplam karaciğer, sağ lob ve sol lob volümleri ölçüldü. Sol lob ağırlığının total karaciğer ağırlığına oranı (rezidü) hesaplandı ve olgular bu orana göre iki gruba ayrıldı. Bu oranın >= 30% olduğu Grup 1'de 78 olgu, < %30 olduğu Grup 2'de 58 olgu yer aldı. Bulgular: Segment 4 arteri olguların 85'inde sol hepatik arterden, 51'inde ise varyasyonel olarak diğer arterlerden çıkış göstermekteydi. Gruplar arası karşılaştırmalarda total volümler (p=0,775) arasında anlamlı fark bulunmazken, sağ lob (p=0,003) ve sol lob (p=0,000) volümleri arasında anlamlı farklılık saptandı. İki grup arasında Sg4A çıkış yeri varyasyonlarının anlamlı değişiklik göstermediği saptandı (p=0,82). Cinsiyete göre yapılan karşılaştırmada kadın olgularda daha fazla rezidü olduğu bulundu (p=0,013). Sonuç: Sonuçlarımız segment 4 arteri çıkış yeri varyasyonlarının sol lobun total karaciğer volümüne etkisinin olmadğını göstermekte olup daha kapsamlı ileri çalışmaların gerekliliğini ortaya koymaktadır.

Radiological evaluation in living donor liver transplantation (LDLT): the effets of variations in segment 4 artery on the ratio of left lobe volume to total liver volume

Aim: The aim of this study was to evaluate whether the variations in the origin of the segment 4 artery effects the left liver lobe volume ratio to the total liver volume in living donor liver transplantation (LDLT). Material and Methods: Multiphasic CT images were obtained in 136 potential donors (70 men, 66 women). The mean age was 32.6±9 years (ranging from 19 to 53). Volume-rendering techniques were used to evaluate hepatic arteries. The origins of the segment 4 arteries were noted. The volumes of the right lobe, the left lobe and the total liver were measured in each case. The ratios of the left lobe volume to the total liver volume were calculated and subjects were divided into two groups based on this ratio. There were 78 cases with this ratio of >= 30 % and 58 cases with this ratio of < 30% in Group1 and Group 2, respectively. Results: The origins of the segment 4 artery were left hepatic artery in 85 cases and variational in 51 cases. The significant difference was shown in right (p=0,003) and left lobe (p=0,000) volumes between two groups whereas not shown in total liver volumes (p=0,775). No significant difference was observed in origins of segment 4 arteries between two groups (p=0,82). Women significantly have greater ratios of left lobe volume than men (p=0,013). Conclusion: Our results indicate that the variations in the origin of the segment 4 arteries have no effects on the ratio of left lobe volume to total volume, and merits further study.

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1. Emond JC, Renz JF, Ferrell LD, Rosenthal P, Lim RC, Roberts JP. Functional analysis of grafts from living donors: implications for the treatment of older recipients. Ann Surg 1996;224(4):544-52.
2. Lo CM, Fan ST, Liu CL. Extending the limit on the size of adult recipient in living donor liver transplantation using extended right lobe graft. Transplantation 1997;63(10):1524-8.
3. Francavilla A, Zeng Q, Polimeno L, Carr BI, Sun D, Porter KA. et al. Small-for-size liver transplanted into larger recipient: A model of hepatic regeneration. Hepatology 1994;19(1):210-6.
4. Aramaki O, Sugawara Y, Kokudo N, Takayama T, Makuuchi M. Branch patch reconstruction in living donor liver transplantation: arterialization of grafts with replaced type arteries. Transplantation 2006;82:1541e3.
5. Takatsuki M, Chiang YC, Lin TS, Wang CC, Concejero A, Lin CC et al. Anatomic and technical aspects of hepatic artery reconstruction in living donor liver transplant. Surgery 2006;140(5):824-8.
6. Guiney MJ, Kruskal JB, Sosna J, Hanto DW, Goldberg SN, Raptopoulos V. Multidedector row CT of relevant vascular anatomy of the surgical plane in split-liver transplantation. Radiology 2003;229(2):401-7.
7. Xu X, Zheng SS. Variation and reconstruction of the hepatic artery in liver transplantation. Hepatobiliary Pancreat Dis Int 2006;5(2):170-2.
8. Macdonald DB, Haider MA, Khaili K, Kim TK, O'Malley M, Greig PD. et al. Relationship be- tween vascular and biliary anatomy in living liver donors. AJR Am J Roentgenol 2005;185(1)247-52.
9. Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 1966;112(3):337-47.
10. Couinaud C. Le Foie: Etudes Anatomiques et Chirugicales. Paris: Mason1957
11. Radtke A, Sotiropoulos GC, Nadalin S, Molmenti EP, Schroeder T, Saner FH. et al. Preoperative volume prediction in adult live donor liver transplantation: 3-D CT volumetry approach to prevent miscalculation. Eur J Med Res 2008;28;13(7):319-26.
12. Karakaş H, Duran C, Yılmaz S, Sağır Kahraman A. Canlı vericili karaciğer naklinde sanal cerrahi: 64 kesitli çok kesitli bilgisayarlı tomografi volümetrinin gerçek greft volümü ile karşılaştırılması. Türk Radyoloji Bülteni 2007 (Ek 1);13:43.
13. Hiroshige S, Shimada M, Harada N, Shiotani S, Ninomiya M, Minagawa R. et al. Accurate preoperative estimation of liver-graft volumetry using three-dimensional computed tomography. Transplantation 2003;15;75(9):1561-4.
14. Lamade W, Glombitza G, Fischer L, Chiu P, Cardenas CE Sr, Thorn M. et al. The impact of 3-dimen- sional reconstructions on operation planning in liver surgery. Arch Surg 2000;135(11):1256-61.
15. Byun JH, Kim TK, Lee SS, Lee JK, Ha HK, Kim AY. et al. Evaluation of the hepatic artery in potential donors for living donor liver transplantation by computed tomography angiography using multidetector row computer tomography: comparison of volume rendering and maximum intensity projection techniques. J Comput Assist Tomogr 2003;27:125e31.
16. Erbay N, Raptopoulos V, Pomfret EA, Kamel IR, Kruskal JB. Living donor liver transplantation in adults: vascular variants important in surgical planning for donors and recipients. AJR Am J Roentgenol 2003;181(1):109-14.
17. Vauthey JN, Abdalla EK, Doherty DA, Gertsch P, Fenstermacher MJ, Loyer EM. et al. Body surface area and body weight predict total liver volume in Western adults. Liver Transpl 2002;8(3):233-40.
18. Klink T, Simon P, Knopp C, Ittrich H, Fischer L, Adam G. et al. Liver remnant regeneration in donors after living donor liver transplantation: long-term follow-up using CT and MR imaging. Rofo 2014;186(6):598-605.
19. Tanemura A, Mizuno S, Wada H, Yamada T, Nobori T, Isaji S. et al. Donor age affects liver regeneration during early period in the graft liver and late period in the remnant liver after living donor liver transplantation. World J Surg 2012;36(5):1102-11.
20. Poovathumkadavil A, Leung KF, Al Ghamdi HM, Othman Iel H, Meshikhes AW. Standard formula for liver volume in Middle Eastern Arabic adults. Transplant Proc 2010;42(9):3600-5.
21. Chan SC, Liu CL, Lo CM, Lam BK, Lee EW, Wong Y et al. Estimating liver weight of adults by body weight and gender. World J Gastroenterol 2006;14;12(14):2217-22.
22. Chouker A, Martignoni A, Dugas M, Eisenmenger W, Schauer R, Kaufmann I et al. Estimation of liver size for liver transplantation: the impact of age and gender. Liver Transpl 2004;10(5):678-85.