Purpose: In the last three decades liver transplantation (LT) has been
established as a standard procedure for end-stage liver disease. However,
the shortage of donor livers is the most significant factor inhibiting
further application of clinical liver transplantation. In Korea, where
B-hepatitis is endemic, most patients waiting for LT are adult with
B-hepatitis associated end stage liver disease. Safe, in situ splitting of a
cadaver donor liver for two separate adult recipients would be an attractive
way to decrease the deaths of adult patients while waiting for organs. Split
grafts weighing more than 1% of the recipient’s body weight (Graft to
Recipient Weight Ratio, GRWR>1%) should be transplanted in order to
adequately meet postoperative metabolic needs. We investigated whether one
cadaver liver can be split into two so that each graft has a GRWR>1%.
Methods: Between January 1999 and December 1999 at Guro medical
center, we selected 47 patients diagnosed as early gastric cancer (EGC) or
early stage colon cancer and reviewed their pre-operative abdominal CT films
for use in our study. Pictures of CT films were taken with a digital camera
and converted to TIF files in order to calculate the standard liver volumes
which were then divided by the plane that represented two operative methods
proposed in this study. First, we performed a Rt. lobectomy along the right
side of the middle hepatic vein to increase the function of segment Ⅳ by
preventing venous congestion. Second, we performed a Lt. lobectomy with
hepatic IVC to save the volume of the caudate lobe (segment Ⅰ).
Results: The body index of the 47 cases was distributed from -10% to
20%. The standard whole liver volume was 1266±299 ㎖ (Mean±SD). Rt. lobe
volume was 751±188 ㎖, and Lt. lobe volume was 515±154 ㎖. Each result was
no less than 1% of 75 ㎏ and 50 ㎏ adult’s body weight. Conclusion:
On average, the GRWR of the Rt. lobe is more than 1% in a 75 ㎏ adult by
itself and that of the Lt. lobe can also be above 1% in a 50 ㎏ adult by
maximizing the function of segments Ⅰ and Ⅳ using the surgical techniques
mentioned above. Therefore, we would be able to successfully spilt a cadaver
donor liver to a 75 ㎏ and a 50 ㎏ adult recipient, respectively.
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