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1.
Surg Technol Int ; 13: 191-5, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15744690

RESUMO

For living donor liver transplantation (LDLT), accurate diagnostic evaluation is essential. Problems arise in assessment of the vascular, bile duct anatomy, liver graft volume, and vascular territories involved. Requirements for the realization of decision-support and enhanced precision in the planning of surgery in LDLT engineering fields are a three-dimensional (3D) visualization system that improves anatomic assessment, allows for interactive surgery planning, and acts as an intraoperative guide. Thirteen LDLT candidates and three LDLT recipients were assessed by "multislice" computer-tomographic examinations. Image processing for 3D visualization included segmentation and calculation of centre lines. A hierarchical mathematical model representing the vascular and biliary tree was created, which allowed calculation of individual vascular territories. Precision of 3D computed tomography (CT)-based visualizations was superior to diagnostic modalities used currently. In addition to detection of decisive anatomic variants, computerized interactive insertion of splitting lines allowed for better planning of the surgical approach and image-guided surgery. 3D CT-based visualization in LDLT facilitates diagnostic evaluation with high accuracy. Multiple examinations, especially with regard to invasive diagnostics, may be avoided. Surgical strategy was directly influenced by the detection of vascular and biliary variants.


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional , Transplante de Fígado/métodos , Doadores Vivos , Intensificação de Imagem Radiográfica , Meios de Contraste , Feminino , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Fígado/anatomia & histologia , Fígado/fisiologia , Circulação Hepática/fisiologia , Transplante de Fígado/efeitos adversos , Masculino , Seleção de Pacientes , Cuidados Pré-Operatórios/métodos , Prognóstico , Medição de Risco , Estudos de Amostragem , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
2.
Clin Transpl ; : 83-90, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-16704140

RESUMO

Eurotransplant introduced a new allocation policy in January 2003 to increase the number of liver transplants by offering centers an incentive to split deceased donor livers for 2 recipients. Centers were granted the option of choosing a suitable recipient for the second portion of the split liver from their own waiting list and, to increase the awareness for liver splitting, centers were asked by the Eurotransplant duty officer whether they would consider splitting whenever a liver that met the 50/50 rule (donor age <50 and weight >50 kg) was available. During the first year after implementing this policy, split-liver transplants increased by 67% and again by 10% during the second year (a total of 288 transplants in the 2-year period). The number of pediatric recipients of a split liver increased from 44 in 2002 to 76 in 2004 and the pediatric waiting list decreased by 36% (73 to 47) one year after implementation of the new policy. More than 95% of the 288 split liver transplants involved one adult and one pediatric recipient. Nearly three-quarters of the split liver transplants were performed at 3 centers with both a pediatric and adult waiting list and with surgeons experienced in the procedure. We conclude that Eurotransplant's liver allocation policy has increased the number of liver transplants, particularly among children, by rewarding centers that split livers for transplantation to 2 recipients without prolonging cold ischemia time. The number of centers that could benefit from this policy will increase as more surgeons are trained in the splitting procedure.


Assuntos
Transplante de Fígado/métodos , Obtenção de Tecidos e Órgãos/organização & administração , Adolescente , Adulto , Criança , Pré-Escolar , Europa (Continente) , Feminino , Humanos , Lactente , Recém-Nascido , Transplante de Fígado/estatística & dados numéricos , Masculino , Fatores de Tempo , Coleta de Tecidos e Órgãos , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Listas de Espera
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