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  • Schroeder, Tobias  (7)
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  • 1
    In: Transplantation Journal, 2012, Vol.94(11), pp.1138-1144
    Description: BACKGROUND: Preoperative imaging and donor selection are cardinal components of adult-to-adult live donor liver transplantation (ALDLT). The purpose of this study was to evaluate our three-dimensional (3D) computed tomography image-derived computer-assisted surgical planning (3D CASP) in ALDLT. METHODS: Eighty-three consecutive ALDLTs (71 right and 12 left) were planned with 3D CASP. Graft, remnant, and total liver volume compliance were calculated and compared with actual intraoperative values. Computed risk analysis encompassing territorial liver mapping, functional (safely drained) volumes, and outflow congestion volumes in grafts and remnants allowed for the individualized management of the middle hepatic vein (MHV). RESULTS: Graft volume compliance was 13.5%±4.4%. Three small-for-size (SFS) grafts with lethal SFS syndrome (SFSS) had nonsignificant volume compliance with maximal graft volume-body weight ratios of less than 0.83. Seven SFS grafts with reversible or absent SFSS showed maximal graft volume-body weight ratios of 0.9 to 1.16. Significant differences were identified for (a) virtual graft and remnant congestion volumes of risky versus nonrisky MHV types (49%±6% and 34%±7% vs. 29%±8% and 33%±12%, P〈0.001 and P〈0.02, respectively) and (b) virtual mean functional versus surgical volumes of grafts (527±119 vs. 963±176 mL, P〈0.0001) and remnants (419±182 vs. 640±213 mL, P〈0.001). CONCLUSIONS: CASP allowed for (a) prevention of SFSS in extremely small grafts by predicting donor liver plasticity and (b) individualized MHV management for both donors and recipients based on functional graft/remnant volume analysis.
    Keywords: Donors ; Computed Tomography ; Hepatic Vein ; Mapping ; Imaging ; Plasticity (Functional) ; Computed Tomography ; Donors ; Mapping ; Plasticity (Functional) ; Hepatic Vein ; Imaging ; Transplantation;
    ISSN: 0041-1337
    E-ISSN: 15346080
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  • 2
    In: Transplantation, 2010, Vol.89(12), pp.1518-1525
    Description: BACKGROUND.: The knowledge of “venous dominance” is essential to prevent serious venous congestion in live donor liver transplantation and extended liver resections. AIMS.: The purpose of our study was to delineate our proposed anatomic-functional classification of hepatic venous drainage. METHODS.: One hundred forty consecutive live liver donor candidates underwent three-dimensional computed tomography reconstructions and three-dimensional virtual hepatectomies. Five different venous dominance types were defined on drainage volumes or territories. “Risky” configurations were identified and classified. RESULTS.: The right hepatic vein (RHV) was dominant for the entire liver and right hemiliver (RHH) in most (83.5%) cases irrespective of the presence of inferior (accessory) hepatic veins (IHVs). The middle hepatic vein (MHV) was dominant for the total liver (TL) in 15.5% of cases and for the RHH in 27% of cases. The left hepatic vein was almost always (92%) dominant for the left hemiliver. When associated with a large IHV drainage volume, a RHV/IHV complex dominant for the TL led to a RHH dominant MHV (mean 59.5%RHH) if the IHV was not reconstructed. CONCLUSIONS.: Our proposed anatomic-functional classification provides a valuable insight into hepatic vein dominance patterns. RHH venous drainage patterns at “high risk” for venous congestion include (1) a dominant MHV for the TL and (2) a dominant RHV/IHV complex with a large IHV drainage volume.
    Keywords: Hepatic Veins -- Pathology ; Image Processing, Computer-Assisted -- Methods ; Liver -- Blood Supply ; Liver Transplantation -- Methods ; Tomography, X-Ray Computed -- Methods;
    ISSN: 0041-1337
    E-ISSN: 15346080
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  • 3
    Language: English
    In: Surgery, February 2013, Vol.153(2), pp.189-199
    Description: In adult live donor liver transplantation, postoperative venous congestion of graft and remnant livers can lead to life-threatening complications. The purpose of this study was to evaluate the safety and benefits of our 3-dimensional, computed tomographic, computer-assisted donor hepatectomy using the “carving” partitioning technique. Eighty-three consecutive adult live donor liver transplantations were performed based on data obtained from individualized preoperative 3-dimensional, computed tomographic reconstructions and virtual graft hepatectomies. There were 71 right and 12 left grafts. Small grafts (graft volume body weight ratio, 〈1.0) were used in 20 cases. We observed no clinically important differences in postoperative function between right and left grafts. Four recipients developed lethal small-for-size syndrome. Reversible small-for-size syndrome was observed in a right graft recipient and in 2 right graft donors. Preoperative 3-dimensional, computed tomographic, computer-assisted planning using virtual liver partitioning allowed for: (1) an individualized carving technique based on specific donor anatomic characteristics, (2) donor safety based on individualized patterns of venous outflow, and (3) optimized drainage of the medial area of the graft based on the preferential inclusion of the middle hepatic vein.
    Keywords: Universities And Colleges -- Methods ; Liver Transplantation -- Methods;
    ISSN: 0039-6060
    E-ISSN: 1532-7361
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  • 4
    Language: English
    In: Journal of Surgical Research, 2011, Vol.166(1), pp.146-155
    Description: Venous drainage patterns are of vital importance in live donor liver transplantation. The purpose of this study was to delineate “anatomical-topographical” and “territorial-physiologic” patterns of the middle hepatic vein (MHV) in a 3-D liver model as determined by the Pringle line and its drainage volume of the right and left hemilivers. One hundred thirty-seven consecutive live donor candidates were evaluated by 3-D CT reconstructions and virtual hepatectomies. Based on right (R) and left (L), anatomical (A) and territorial (T) belonging patterns of the MHV, each individual was assigned to one of four possible types: type I:A –T ; type II:A –T ; type III:A –T ; type IV:A –T . Couinaud's anatomical MHV variants A–C were subsequently included in our combined anatomical/territorial MHV belonging classification. The MHV showed a significant predominance of right “anatomical” (59.1%) and left “territorial” belonging patterns (65.7%). The paradoxical combinations A –T (type III) and A –T (type IV) were encountered in 36.5% and 11.7% of cases, respectively. The constellations Couinaud's A-belonging type IV and Couinaud's C-belonging type IV were predictive of right hemiliver venous congestion. (1) Almost half of all livers in our series had paradoxical “anatomical”/“territorial” MHV belonging patterns that placed them at risk for right and left hepatectomies. (2) The proposed combined “anatomical”/“territorial” MHV belonging types (I–IV) provide useful preoperative information. (3) Combined types III and IV as well as Couinaud's A–IV, and Couinaud's C–IV should be considered particularly risky for venous congestion in right hemiliver grafts and in extended left hepatectomies.
    Keywords: Liver Surgery ; Living Donor Liver Transplantation ; Liver Anatomy ; 3-D Reconstruction ; 3-D CT ; Liver Imaging ; Liver Venous Drainage ; Hepatic Vein Anatomy ; Hepatic Vein Dominance ; Hepatic Vein Classification
    ISSN: 0022-4804
    E-ISSN: 1095-8673
    Source: ScienceDirect Journals (Elsevier)
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  • 5
    Language: English
    In: World journal of gastroenterology, 21 May 2015, Vol.21(19), pp.6008-17
    Description: To investigate middle hepatic vein (MHV) management in adult living donor liver transplantation and safer remnant volumes (RV). There were 59 grafts with and 12 grafts without MHV (including 4 with MHV-5/8 reconstructions). All donors underwent our five-step protocol evaluation containing a preoperative protocol liver biopsy Congestive vs non-congestive RV, remnant-volume-body-weight ratios (RVBWR) and postoperative outcomes were evaluated in 71 right graft living donors. Dominant vs non-dominant MHV anatomy in total liver volume (d-MHV/TLV vs nd-MHV/TLV) was constellated with large/small congestion volumes (CV-index). Small for size (SFS) and non-SFS remnant considerations were based on standard cut-off- RVBWR and RV/TLV. Non-congestive RVBWR was based on non-congestive RV. MHV and non-MHV remnants showed no significant differences in RV, RV/TLV, RVBWR, total bilirubin, or INR. SFS-remnants with RV/TLV 〈 30% and non-SFS-remnants with RV/TLV ≥ 30% showed no significant differences either. RV and RVBWR for non-MHV (n = 59) and MHV-containing (n = 12) remnants were 550 ± 95 mL and 0.79 ± 0.1 mL vs 568 ± 97 mL and 0.79 ± 0.13, respectively (P = 0.423 and P = 0.919. Mean left RV/TLV was 35.8% ± 3.9%. Non-MHV (n = 59) and MHV-containing (n = 12) remnants (34.1% ± 3% vs 36% ± 4% respectively, P = 0.148. Eight SFS-remnants with RVBWR 〈 0.65 had a significantly smaller RV/TLV than 63 non-SFS-remnants with RVBWR ≥ 0.65 [SFS: RV/TLV 32.4% (range: 28%-35.7%) vs non-SFS: RV/TLV 36.2% (range: 26.1%-45.5%), P 〈 0.009. Six SFS-remnants with RV/TLV 〈 30% had significantly smaller RVBWR than 65 non-SFS-remnants with RV/TLV ≥ 30% (0.65 (range: 0.6-0.7) vs 0.8 (range: 0.6-1.27), P 〈 0.01. Two (2.8%) donors developed reversible liver failure. RVBWR and RV/TLV were concordant in 25%-33% of SFS and in 92%-94% of non-SFS remnants. MHV management options including complete MHV vs MHV-4A selective retention were necessary in n = 12 vs n = 2 remnants based on particularly risky congestive and non-congestive volume constellations. MHV procurement should consider individual remnant congestive- and non-congestive volume components and anatomy characteristics, RVBWR-RV/TLV constellation enables the identification of marginally small remnants.
    Keywords: Liver Volume ; Living Donor Liver Transplantation ; Remnant Volume ; Small-for-Size ; Small-for-Size Syndrome ; Living Donors ; Hepatectomy -- Adverse Effects ; Hepatic Veins -- Surgery ; Hyperemia -- Etiology ; Liver -- Surgery ; Liver Transplantation -- Adverse Effects
    ISSN: 10079327
    E-ISSN: 2219-2840
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  • 6
    Language: English
    In: The Journal of surgical research, March 2011, Vol.166(1), pp.146-55
    Description: Venous drainage patterns are of vital importance in live donor liver transplantation. The purpose of this study was to delineate "anatomical-topographical" and "territorial-physiologic" patterns of the middle hepatic vein (MHV) in a 3-D liver model as determined by the Pringle line and its drainage volume of the right and left hemilivers. One hundred thirty-seven consecutive live donor candidates were evaluated by 3-D CT reconstructions and virtual hepatectomies. Based on right (R) and left (L), anatomical (A) and territorial (T) belonging patterns of the MHV, each individual was assigned to one of four possible types: type I:A(R)-T(R); type II:A(L)-T(L); type III:A(R)-T(L); type IV:A(L)-T(R). Couinaud's anatomical MHV variants A-C were subsequently included in our combined anatomical/territorial MHV belonging classification. The MHV showed a significant predominance of right "anatomical" (59.1%) and left "territorial" belonging patterns (65.7%). The paradoxical combinations A(R)-T(L) (type III) and A(L)-T(R) (type IV) were encountered in 36.5% and 11.7% of cases, respectively. The constellations Couinaud's A-belonging type IV and Couinaud's C-belonging type IV were predictive of right hemiliver venous congestion. (1) Almost half of all livers in our series had paradoxical "anatomical"/"territorial" MHV belonging patterns that placed them at risk for right and left hepatectomies. (2) The proposed combined "anatomical"/"territorial" MHV belonging types (I-IV) provide useful preoperative information. (3) Combined types III and IV as well as Couinaud's A-IV, and Couinaud's C-IV should be considered particularly risky for venous congestion in right hemiliver grafts and in extended left hepatectomies.
    Keywords: Hepatic Veins ; Living Donors ; Hepatectomy -- Methods ; Liver Transplantation -- Methods
    ISSN: 00224804
    E-ISSN: 1095-8673
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 7
    Language: English
    In: World Journal of Surgery, 2009, Vol.33(9), pp.1941-1951
    Description: Byline: Arnold Radtke (1,2), George Sgourakis (1,2,5), Georgios C. Sotiropoulos (1,2), Ernesto P. Molmenti (2), Silvio Nadalin (2), Tobias Schroeder (3), Fuat Saner (2), Andrea Schenk (4), Vito R. Cincinnati (2), Cristoph E. Broelsch (2), Hauke Lang (1,2,6), Massimo Malago (2) Abstract: Background Intrahepatic anatomic variations have been associated with both morbidity and mortality associated with live donor liver transplantation. The aim of our study was to evaluate central hilar and peripheral segmental vascular/biliary anatomy in right graft living donor liver transplantation. Methods From January 2003 to August 2007, three-dimensional (3D) computed tomography (CT) reconstructions and virtual 3D hepatectomies were performed in 71 consecutive right graft live liver donors. A combined two-level classification system addressing the four possible combinations of normal (N) and abnormal (A) central hilar and peripheral features based on both the existing classification and our own classification for portal (portal vein, PV), arterial (hepatic artery, HA) and biliary (bile duct, BD) systems was defined as follows: type I, N/N type II, N/A type III, A/N and type IV, A/A. Results A simultaneous normal central hilar and peripheral segmental (N/N) anatomy for each system (PV, HA, BD) was found in 〈50% of grafts. The highest incidence of complex vascular and biliary reconstructions was observed with grafts having abnormal central (type III) or combined abnormal central/peripheral (type IV) anatomy. Central hilar arterial and biliary anomalies were predictors of morbidity by both univariable and multivariable analyses. Conclusions Our two-level classification and 3D imaging techniques allowed a cautious surgical approach in high-risk cases. Central hilar anatomic variants of the arterial and biliary systems were associated with increased morbidity. Further randomized trials will help determine the precise extent of our observations. Author Affiliation: (1) Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital Mainz, Mainz, Germany (2) Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Essen, Germany (3) Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany (4) MeVis Center for Medical Diagnostic Systems and Visualization, University of Bremen, Bremen, Germany (5) 11 Mantzarou str., Neo Psychiko, Athens, 15451, Greece (6) Langenbeckstr. 1, Mainz, 55131, Germany Article History: Registration Date: 02/06/2009 Online Date: 15/07/2009
    Keywords: Morbidity -- Patient Outcomes ; Mortality ; Organ Transplantation ; Tissue Donation;
    ISSN: 0364-2313
    E-ISSN: 1432-2323
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