1 Department of Radiology, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06520-8042.
AJR Am J Roentgenol. 2014 Apr;202(4):W343-8. doi: 10.2214/AJR.13.10677.
The objective of our study was to catalog the anatomic features shown on preoperative CT that precluded living-donor liver donation.
We retrospectively reviewed the records of 159 consecutive candidates who were evaluated for potential right or left lobe liver donation from November 2007 to January 2012 using MDCT angiography and cholangiography. For the potential donors who were excluded secondary to findings depicted on preoperative imaging, we determined which findings precluded donation.
In two (1%) patients who had no prohibitive preoperative imaging findings, anatomic abnormalities were detected intraoperatively that precluded transplantation. Sixty-one (38%) candidates were excluded from liver donation on the basis of imaging findings. Of these patients, 40 (66%) had inadequate liver volume, 14 (23%) had vascular or biliary variants, five (8%) had steatosis, and two (3%) were found to have renal cell carcinoma. Arterial and biliary variants were the most common reason for exclusion based on anatomic findings.
Inadequate liver volume was the most common reason for exclusion based on preoperative imaging. Arterial and biliary anatomic variants precluded both right and left lobe transplantation in a number of cases.
本研究旨在对术前 CT 显示的导致活体肝供体捐献无法进行的解剖特征进行分类。
我们回顾性分析了 2007 年 11 月至 2012 年 1 月期间 159 例连续候选者的记录,这些候选者通过 MDCT 血管造影和胆管造影评估了右叶或左叶肝供体的潜在可能性。对于因术前影像学表现而被排除的潜在供体,我们确定了哪些发现导致了捐献的排除。
在两名(1%)无术前影像学禁忌证的患者中,术中发现解剖异常,导致移植无法进行。61 名(38%)候选者因影像学表现而被排除在肝移植之外。这些患者中,40 名(66%)肝体积不足,14 名(23%)有血管或胆管变异,5 名(8%)有脂肪变性,2 名(3%)有肾细胞癌。动脉和胆管变异是基于解剖发现排除的最常见原因。
基于术前影像学,肝体积不足是最常见的排除原因。动脉和胆管解剖变异在许多情况下导致右叶和左叶移植均无法进行。