TY - JOUR
T1 - Postoperative liver dysfunction in living donors after left-sided graft hepatectomy
T2 - Portal venous occlusion of the medial segment after lateral segmentectomy and hepatic venous congestion after left lobe hepatectomy
AU - Kumamoto, K.
AU - Mizuno, S.
AU - Kuriyama, N.
AU - Ohsawa, I.
AU - Kishiwada, M.
AU - Hamada, T.
AU - Usui, M.
AU - Sakurai, H.
AU - Tabata, M.
AU - Isaji, S.
N1 - Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2012/3
Y1 - 2012/3
N2 - Background: The aim of this study was to evaluate how sacrifice of the portal vein and/or hepatic vein affects remnant liver dysfunction after lateral segmentectomy or left lobe hepatectomy. Materials and methods: Among 130 patients who underwent donor hepatectomy between March 2002 and July 2011, we enrolled lateral segment (n = 15) and left lobe donors (n = 40). We evaluated the postoperative courses and the territory of venous obstruction or congestion based on the sacrificed portal vein or hepatic vein after the donor operation: lateral segment grafts (P4a, P4b, LV4) and left lobe grafts (MV5, MV8) according to the results analyzed by MeVis Distant Service. Results: Among lateral segment donors, the predicted sacrificed territory of portal vein and hepatic vein was 14.3% (7.3%19.4%) in P4a + 4b: (P4a: 8.6%, P4b: 5.8%) and 2.9% (0%8.4%) in LV4, respectively. On the other hand, in left lobe donors, the predicted congestive territory of the hepatic vein was 17.6% (2.8%33.0%) in MV5 + 8 (7.8% in MV5 and 9.8% in MV8, respectively). The incidence of patients whose postoperative peak aspartate aminotransferase (AST) or alanine aminotransferase levels were higher than 500 IU/L was 20% in the lateral segment donors and 5% in the left lobe donors. The peak postoperative AST levels and territory of MV5 + 8 showed a significant positive correlation (R = 0.569, P <.05) among left lobe donors. Conclusion: Territories of P4 in lateral segment donors and MV5 + 8 in left lobe donors impacted postoperative liver dysfunction. It is important to recognize the precise territory of the portal vein and the hepatic vein before the donor operation.
AB - Background: The aim of this study was to evaluate how sacrifice of the portal vein and/or hepatic vein affects remnant liver dysfunction after lateral segmentectomy or left lobe hepatectomy. Materials and methods: Among 130 patients who underwent donor hepatectomy between March 2002 and July 2011, we enrolled lateral segment (n = 15) and left lobe donors (n = 40). We evaluated the postoperative courses and the territory of venous obstruction or congestion based on the sacrificed portal vein or hepatic vein after the donor operation: lateral segment grafts (P4a, P4b, LV4) and left lobe grafts (MV5, MV8) according to the results analyzed by MeVis Distant Service. Results: Among lateral segment donors, the predicted sacrificed territory of portal vein and hepatic vein was 14.3% (7.3%19.4%) in P4a + 4b: (P4a: 8.6%, P4b: 5.8%) and 2.9% (0%8.4%) in LV4, respectively. On the other hand, in left lobe donors, the predicted congestive territory of the hepatic vein was 17.6% (2.8%33.0%) in MV5 + 8 (7.8% in MV5 and 9.8% in MV8, respectively). The incidence of patients whose postoperative peak aspartate aminotransferase (AST) or alanine aminotransferase levels were higher than 500 IU/L was 20% in the lateral segment donors and 5% in the left lobe donors. The peak postoperative AST levels and territory of MV5 + 8 showed a significant positive correlation (R = 0.569, P <.05) among left lobe donors. Conclusion: Territories of P4 in lateral segment donors and MV5 + 8 in left lobe donors impacted postoperative liver dysfunction. It is important to recognize the precise territory of the portal vein and the hepatic vein before the donor operation.
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U2 - 10.1016/j.transproceed.2012.01.023
DO - 10.1016/j.transproceed.2012.01.023
M3 - Article
C2 - 22410009
AN - SCOPUS:84858267415
SN - 0041-1345
VL - 44
SP - 332
EP - 337
JO - Transplantation Proceedings
JF - Transplantation Proceedings
IS - 2
ER -