Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
-
While inflow occlusion techniques such as Pringle's maneuver are accepted methods of reducing bleeding without inducing liver injury during liver surgery, donor hepatectomy for living donor liver transplantation is currently performed without inflow occlusion for fear that injury to the graft may result. We have performed donor hepatectomy for 12 years using selective intermittent inflow occlusion, a technique in which the portion used to form the graft is perfused during hepatectomy. Starting in November 2000, we applied intermittent Pringle's maneuver to donor hepatectomy in 81 cases of living donor liver transplantation. ⋯ Maximum ALT values in the recipients of the total ischemia group was lower, albeit not significantly, than in other groups. Total inflow occlusion can be applied to living donor hepatectomy without causing graft injury. In conclusion, because the transection surface is blood-free, there is decreased risk to the donor during living donor liver transplantation surgery, and surgeons should not hesitate to apply this technique because it contributes to donor safety.
-
The standard liver volume (LV) of a recipient is estimated in liver transplantation to determine the minimum LV necessary for the recipient. Simple linear formulas of LV estimation were developed for the Japanese and Caucasian populations. The present study examined the applicability of the reported formulas to the Korean population. ⋯ The Japanese formula produced underestimates for the Korean population (226.9 +/- 289.4 mL), while the Caucasian formula produced random errors (-30.64 +/- 281.5 mL). A better LV estimation formula was established: LV (mL) = 21.585 x BW (kg)(0.732) x BH (cm)(0.225) (adjusted R(2) = 0.59; SE = 275.8 mL). In conclusion, this study indicates that a nonlinear or piecewise linear model is more desirable than a simple linear model for LV estimation in children and adults, because LV / BW and LV / BSA are not constant with age and BSA.