CT volume analysis in living donor liver transplantation: accuracy of three different approaches.

OBJECTIVES: The aim of this retrospective study is to compare and evaluate accuracy of three different approaches of liver volume quantification in living donor transplantations. METHODS: This is a single-center, retrospective study of 60 donors. The total and right lobe liver volumes were analyzed in the portal-venous phase by two independent radiologists who estimated the volumes using manual, semi-automated and automated segmentation methods. The measured right lobe liver volume was compared to the real weight of the graft after back-table examinations. RESULTS: The mean estimated overall liver volume was 1164.4 ± 137.0 mL for manual, 1277.4 ± 190.4 mL for semi-automated and 1240.1 ± 108.5 mL for automated segmentation. The mean estimated right lobe volume was 762.0 ± 122.4 mL for manual, 792.9 ± 139.9 mL for semi-automated and 765.4 ± 132.7 mL for automated segmentation. The mean graft weight was 711.2 ± 142.9 g. The manual method better correlated with the graft weight (r = 0.730) in comparison with the semi-automated (r = 0.685) and the automated (r = 0.699) methods (p < 0.001). The mean error ratio in volume estimation by each application was 12.7 ± 16.6% for manual, 17.1 ± 17.3% for semi-automated, 14.7 ± 16.8% for automated methods. There was a statistically significant difference between the mean error ratio of the manual and the semi-automated segmentations (p = 0.017), and no statistically significant difference between the manual and the automated applications (p = 0.199). CONCLUSION: Volume analysis application better correlates with graft weight, but there is no obvious difference between correlation coefficients of all three methods. All three modalities had an error ratio, of which the semi-automated method showed the highest value. CRITICAL RELEVANCE STATEMENT: Volume analysis application was more accurate, but there is no drastic difference between correlation coefficients of all three methods.

Evolution of Liver Transplantation in Kazakhstan: Two-Era Experience of a Single Center, the First Report.

BACKGROUND: Liver transplantation has been performed in Kazakhstan since 2011. The present study aimed to analyze the outcomes of the most experienced liver transplant center in Kazakhstan. METHODS: Between December 2011 and December 2018, 131 liver transplantations were performed at A.N. Syzganov's National Scientific Center of Surgery. The clinical data of 88 adult patients who underwent living donor liver transplantations from December 2011 to December 2017 were analyzed. The patients were divided into 2 cohorts based on the periods in which the procedure was performed: the early era (2011-2014; n = 25) and the late era (2015-2017; n = 63). The clinical course and outcomes were retrospectively reviewed. RESULTS: There were significant differences in the characteristics of the recipients. The patients who were treated during the late era had significantly better survival rates compared with the early era (1 year, 90.5%; 3 year, 79.6%; vs 1 year, 67.7%; 3 year 63.3%; P < .05). Right lobe grafts were used significantly more frequently during the late era (P < .05), while splenectomy was indicated significantly less frequently (P < .05). We also noted a decrease in the complication rate, including early postoperative mortality (P < .05). CONCLUSIONS: Over the past 7 years, the liver transplant program has been established, and the operative techniques used in living donor liver transplant have changed dramatically. Patient survival has been improving with increased experience.

Extra-Anatomic Jump Graft Arterial Reconstruction Using a Great Saphenous Vein Autograft During Living Donor Liver Transplantation.

BACKGROUND: In living-donor liver transplantation (LDLT), successful microsurgical arterial reconstruction is essential but quite challenging. Dissection of the hepatic artery extending to the celiac trunk is a rare complication during liver transplantation. Kazakhstan is an area in which deceased donor grafts are not sufficient for several reasons, and the availability of graft vessels is limited. METHODS: We herein report the case of a 65-year-old patient who underwent LDLT due to hepatitis B + D virus-coinfected liver cirrhosis complicated by hepatic artery dissection extending to the celiac trunk. Because of massive gastric collateral varices, direct anastomosis to the supraceliac aorta was not possible. Therefore, extra-anatomic jump graft reconstruction was performed from the right iliac artery to the graft's hepatic artery using an autologous graft vein (great saphenous vein). RESULTS: The patient's postoperative period was uneventful. The patient was discharged at 27 days post-transplantation. At the time of writing, the follow-up period is 8 months after transplantation, and the recipient maintains a normal liver function. CONCLUSION: When there is no other option for arterial reconstruction, this method is a feasible option for performing extra-anatomic jump graft reconstruction.

Clinical and Morphologic Diagnostic Assessments of Liver Diseases After Liver Transplant.

OBJECTIVES: At the National Scientific Center of Surgery named A. Syzganova, more than 100 liver transplants have been conducted from 2012 to November 2017. Survival and quality of life of patients in the posttransplant period largely depend on the compliance of patients, monitoring of complications, cause of liver disease, the severity of the condition of patients in the pretransplant period, and the technical features of the operation. The aims of the study were to analyze the results of liver biopsy in patients after liver transplant and to evaluate the value of morphologic studies of the liver for the diagnosis of complications in the posttransplant period. MATERIALS AND METHODS: Liver transplant recipients undergoing liver biopsy between 2012 and 2017 were analyzed. Our study included 40 liver biopsies in 29 patients after orthotopic liver transplant who fulfilled the inclusion criteria. RESULTS: In 51.7% of cases in patients (that is, in 15 of 29 patients), biopsy data revealed changes characteristic of rejection. Biliary complications were found in 10.34% of patients, recurrent liver diseases were confirmed in 17.24% of patients, 3.45% of patients had confirmed cholangitis, and 6.90% of patients were diagnosed with liver steatosis. CONCLUSIONS: Histopathology assessment of allograft liver biopsies plays an important role in the differential diagnosis of posttransplant complications and in identifying the cause of graft damage; having this information can lead to the appropriate therapeutic intervention.