Living Donor Liver Transplantation: The Asian Perspective Chao-Long Chen, Yu-Fan Cheng, Chun-Yen Yu, Hsin-You Ou, Leo Leung-Chit Tsang, Tung-Liang Huang, Tai-Yi Chen, Allan Concejero, Chih-Chi Wang, Shih-Ho Wang, Tsan-Shiun Lin, Yueh-Wei Liu, Chin-Hsiang Yang, Chee-Chien Yong, King-Wah Chiu, Bruno Jawan, Hock-Liew Eng, See Ching Chan, William Wei Sharr, Chung-Mau Lo, Sumihito Tamura, Yasuhiko Sugawara, Norihiro Kokudo, Kwang-Woong Lee, Nam-Joon Yi, Kyung-Suk Suh, Deok-Bog Moon, Sung-Gyu Lee, Chul-Soo Ahn, Shin Huang, Ki-Hun Kim, Tae-Yong Ha, Gi-Wong Song, Dong-Hwan Jung, Gil-Chun Park, Jung-Man Namkoong, Hyung-Woo Park, Yo-Han Park, Cheon-Soo Park, Kyw-Bo Sung, Gi-Young Ko, Dong-Il Gwon, Toskimi Kaido, Kohei Ogawa, Yasuhiro Fujimoto, Takashi Ito, Koji Toniyama, Akira Mori, Yasuhiro Ogura, Shinji Uemoto, Anthony Q. Yap, Yu-Hung Lin, Chun-Yi Liu, Yuan-Cheng Chiang, Chih-Chi Lin, Milljae Shin, Jae-Won Joh, Catherine Kabiling, Tsung-Hui Hu, Sung-Hwa Kang, Bo-Hyun Jung, and Young-Rok Choi
SECTION 1. IMAGE EVALUATION OF FATTY LIVER IN LIVING DONOR LIVER TRANSPLANTATION
Yu-Fan Cheng,1 Chun-Yen Yu,1 Hsin-You Ou,1 Leo Leung-Chit Tsang,1 Tung-Liang Huang,1 Tai-Yi Chen,1 Allan Concejero,2 Chih-Chi Wang,2 Shih-Ho Wang,2 Tsan-Shiun Lin,2 Yueh-Wei Liu,2 Chin-Hsiang Yang,2 Chee-Chien Yong,2 King-Wah Chiu,3 Bruno Jawan,4 Hock-Liew Eng,5 and Chao-Long Chen2,6 Abstract. Preoperative evaluation of donors for living-donor liver transplantation aims to select a suitable donor with optimal graft quality and to ensure donor safety. Hepatic steatosis, a common finding in living liver donors, not only influences the outcome of liver transplantation for the recipient but also affects the recovery of the living donor after partial hepatectomy. Histopathologic analysis is the reference standard to detect and quantify fat in the liver, but it is invasive, and results are vulnerable to sampling error. Imaging can be repeated regularly and allows assessment of the entire liver, thus avoiding sampling error. Selection of appropriate imaging methods demands understanding of their advantages and limitations and the suitable clinical setting. This article describes potential clinical applications for liver fat quantification of imaging methods for fat detection and quantification, with an emphasis on the advantages and limitations of ultrasonography, computed tomography, and magnetic resonance imaging for quantifying liver fat. Keywords: Fatty liver, Ultrasound, CT, MR, Living donor liver transplantation.
L
iving-donor liver transplantation (LDLT) was developed to alleviate organ shortage, especially in Asian countries,
Transplantation
& Volume 97, Number 8S, April 27, 2014
where the cadaveric graft supply is markedly limited. The most serious ethical concern of LDLT is the risk to the healthy donor who will undergo a major operation without any potential health benefit. Therefore, preserving the health of the donors and excluding persons from donation if they are not suitable candidates, for either medical or anatomic reasons, should be the most important priority of the transplant team (1). Imaging is performed to detect liver parenchymal abnormalities that may preclude living-donor transplantation. However, in the vast majority of cases, parenchymal imaging focuses mainly on detecting hepatic steatosis, which, if present in a significant quantity, can cause postoperative graft dysfunction in the recipient and liver dysfunction or failure in the donor. Among living liver donors, the residual liver with a fat content of less than 5% shows better regeneration than one This work was supported by Grant NSC 96-231-B-182A-009 and NSC 94231-B-182A-009 from the National Science Council, Taiwan. The authors declare no conflicts of interest. 1 Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Taiwan. 2 Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Taiwan. 3 Division of Hepatogastroenterology, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan. 4 Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Taiwan. 5 Department of Pathology, Kaohsiung Chang Gung Memorial Hospital, Taiwan. 6 Address correspondence to: Chao-Long Chen, M.D., Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Tai-Pei Road, Niao-Sung, Kaohsiung 83305, Taiwan. E-mail: [email protected] Dr. Yu-Fan Cheng and Dr. Chun-Yen Yu contributed equally to this work. Copyright * 2014 by Lippincott Williams & Wilkins ISSN: 0041-1337/14/9708-00 DOI: 10.1097/TP.0000000000000060
www.transplantjournal.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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SECTION 1. IMAGE EVALUATION OF FATTY LIVER IN LIVING DONOR LIVER TRANSPLANTATION
Yu-Fan Cheng,1 Chun-Yen Yu,1 Hsin-You Ou,1 Leo Leung-Chit Tsang,1 Tung-Liang Huang,1 Tai-Yi Chen,1 Allan Concejero,2 Chih-Chi Wang,2 Shih-Ho Wang,2 Tsan-Shiun Lin,2 Yueh-Wei Liu,2 Chin-Hsiang Yang,2 Chee-Chien Yong,2 King-Wah Chiu,3 Bruno Jawan,4 Hock-Liew Eng,5 and Chao-Long Chen2,6 Abstract. Preoperative evaluation of donors for living-donor liver transplantation aims to select a suitable donor with optimal graft quality and to ensure donor safety. Hepatic steatosis, a common finding in living liver donors, not only influences the outcome of liver transplantation for the recipient but also affects the recovery of the living donor after partial hepatectomy. Histopathologic analysis is the reference standard to detect and quantify fat in the liver, but it is invasive, and results are vulnerable to sampling error. Imaging can be repeated regularly and allows assessment of the entire liver, thus avoiding sampling error. Selection of appropriate imaging methods demands understanding of their advantages and limitations and the suitable clinical setting. This article describes potential clinical applications for liver fat quantification of imaging methods for fat detection and quantification, with an emphasis on the advantages and limitations of ultrasonography, computed tomography, and magnetic resonance imaging for quantifying liver fat. Keywords: Fatty liver, Ultrasound, CT, MR, Living donor liver transplantation.
L
iving-donor liver transplantation (LDLT) was developed to alleviate organ shortage, especially in Asian countries,
Transplantation
& Volume 97, Number 8S, April 27, 2014
where the cadaveric graft supply is markedly limited. The most serious ethical concern of LDLT is the risk to the healthy donor who will undergo a major operation without any potential health benefit. Therefore, preserving the health of the donors and excluding persons from donation if they are not suitable candidates, for either medical or anatomic reasons, should be the most important priority of the transplant team (1). Imaging is performed to detect liver parenchymal abnormalities that may preclude living-donor transplantation. However, in the vast majority of cases, parenchymal imaging focuses mainly on detecting hepatic steatosis, which, if present in a significant quantity, can cause postoperative graft dysfunction in the recipient and liver dysfunction or failure in the donor. Among living liver donors, the residual liver with a fat content of less than 5% shows better regeneration than one This work was supported by Grant NSC 96-231-B-182A-009 and NSC 94231-B-182A-009 from the National Science Council, Taiwan. The authors declare no conflicts of interest. 1 Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Taiwan. 2 Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Taiwan. 3 Division of Hepatogastroenterology, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan. 4 Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Taiwan. 5 Department of Pathology, Kaohsiung Chang Gung Memorial Hospital, Taiwan. 6 Address correspondence to: Chao-Long Chen, M.D., Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Tai-Pei Road, Niao-Sung, Kaohsiung 83305, Taiwan. E-mail: [email protected] Dr. Yu-Fan Cheng and Dr. Chun-Yen Yu contributed equally to this work. Copyright * 2014 by Lippincott Williams & Wilkins ISSN: 0041-1337/14/9708-00 DOI: 10.1097/TP.0000000000000060
www.transplantjournal.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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