Value of abdominal ultrasound study in the evaluation of the liver parenchyma in potential related donors of liver fragments

A comprehensive examination, involving ultrasonography (US) in 55 potential related donors of liver fragments, revealed no signs of diffuse liver lesion (DLL) in 45 cases (Group A), these were found in 10 cases (Group B).

Liver fragment taking surgery was performed in Group A patients 1–2 weeks after US. All the 45 patients in this group were found to have a normal US pattern of the liver, as verified by its histological studies in all the cases; all these patients had also a mass body index (MBI) of lower than 25 kg/m2 . In Group B, all the 10 patients had the US signs comparable with mild or moderate DLL (increased liver parenchymal echogenicity, worse visualization of the small branches of the intrahepatic veins and diaphragm, and altered patterns of blood flow in the right hepatic vein) generally concurrent with a higher MBI. After 3–4-month treatment to reduce weight (conditioning), the liver US pattern normalized in 9 of the 10 Group B patients; only one patient with a MBI of 31.6 kg/m2 preserved the signs of mild DLL (histological studies of liver biopsy specimens revealed 10% steatosis in this patient, 2 % steatosis in 2 female patients; this condition was absent in the other 7 patients). All the patients in Group B were also operated on 1–2 weeks after the last US. The recipients from Groups A and B donors had no posttransplantation parenchymal complications.

US in the tints of a gray scale along with the determination of blood flow patterns in the hepatic veins rather significantly shows the normal liver in its potential donors and reduces the need for serial diagnostic liver biopsies and other instrumental studies.

1. Strong R.W., Lynch S.V., Ong T.H. et al. Successful liver transplantation from living donor to her son. N Eng J Med 1990;322:1505–7.

2. Yamaoka Y., Washida M., Honda K. et al. Liver transplantation using a right lobe graft from a living related donor. Transplantation 1994;57:1127–30.

3. Готье С.В., Цирульникова О.М., Филин А.В. и др. Родственная трансплантация печени: первый опыт, перспективы для России. Рос журн гастроэнтерол, гепатол, колопроктол 1999;9(1) Прил 6:111.

4. Константинов Б.А., Готье С.В., Цирульникова О.М. и др. Трансплантация части печени от живого родственного донора: первый клинический опыт. Хирургия 2000;(3):4–9.

5. Brandhagen D., Fidler J., Rosen C. Evaluation of the donor for living donor liver transplantation. Liver Transpl 2003;9(10) Suppl 2):16–8.

6. Rinella M.E., Alonso E., Rao S. et al. Body mass index as a predictor of hepatic steatosis in living liver donors. Liver Transpl 2001;7(5):409–14.

7. Ploeg R.J., D’Assesandro A.M., Knechtle S.J. Risk factor for primary dysfunction after liver transplantationa multvariant analysis. Transplantation 1993;55:807–13.

8. Selzner M., Clavien P.A. Fatty liver in liver transplantation and surgery. Semin Liver Dis 2001;21(1):105–13.

9. Kusyk V.D., Painter D., Fisher J. et al. Clinical experience gained from the use 120 steatotic donor livers for orthotopic liver transplantation. Liver Transpl 2003;9(5):500–5.

10. Berns K.E., Tsiotos G.G., DeSouza N.F. et al. Hepatic stetosis a potential risk factor for major hepatic resection. J Gastrointest Surg 1998;2:292–8.

11. Fan S.T., Lo C.V., Liu C.L. et al. Safety of donors in live donor liver transplantation using right lobe grafts. Arch Surg 2000;135:336–40.

12. Ким Э.Ф. Клинические и хирургические аспекты прижизненного донорства фрагментов печени. Автореф. дис. … д-ра мед. наук. М., 2008.

13. Vetelainen R ., van Vilet A., Gourma D.J. et al. Steatosis as a risk factor in liver surgery. Ann Surg 2007;245(1):20–30.

14. Bohte A.E., van Werven J.R., Stoker B.S. The diagnostic accuracy of US, CT, MRI and 1H-MHS for evaluation of hepatic stetosis compare with liver biopsy: a meta-analysis. Eur Radiol 2011;21(1):87–97.

15. Pacifico L., Martino M.D., Catalano C. et al. T-1 weighted dual-echo MRI for fat quantification in pediatric nonalcoholic fatty diseases. World J Gasroenterol 2011;17(25):3012–9.

16. Limanond P., Raman S.S., Lassman C. et al. Macrovesicular hepatic steatosis in living related liver donors: correlation between CT and histilogical findings. Radiology 2004;230:276–80.

17. Chen C.-H., Lin S.-T., Yang C.-C. et al. The accuracy of sonography in predicting steatosis and fibrosis in chronic hepatitis C. Dig Dis Sci 2008;53:1699–706.

18. Van Ness M.M., Diehl A.M. Is liver biopsy useful in evaluation of patients with chronically elevated enzymes? Ann Intern Med 1989;111:473–8.

19. Hornboll P., Olsen T.S. Fatty changes in the liver: the relation to age, overweight and diabetes mellitus. Acta Pathol Microbiol Immunol Scand 1982; 90(3):199–205.

20. Niederau C., Sonnenberg A., Muller J.E. et al. Sonographic measurements of normal liver, spleen, pancreas and portal vein. Radiology 1983;18(2):537–40.

21. Bolondi L., Bassi S.L., Gaiani S. et al. Liver cirrhosis: changes of Doppler waveform of hepatic veins. Radiology 1991;178:513–6.

22. Joseph A.E., Dewbury K.C., McGuire P.G. Ultrasound in the detection of chronic liver disease (the “bright liver”). Br J Radiol 1979;52(615):184–8.

23. Scatarige J.C., Scott W.W., Donovan S.S. et al. Fatty infiltration of the liver: ultrasonic and computed tomographic correlations. J Ultrasound Med 1984;3:9–14.

24. Saverymuttu S.H., Joseph A.E., Maxwell J.D. Ultrasound scanning in the detection of hepatic fibrosis and stetosis. Br Med J Clin Res 1986;292(6512):13–5.

25. Дибина Т.В., Кошель А.П., Соколов С.А. Гистометрический способ оценки паренхимы печени при трансабдоминальной сонографии. Материалы III Всероссийского национального конгресса лучевых диагностов и терапевтов «Радиология–2009», Москва; с.131–2.

26. Manchini M., Prinster A., Annuzzi G. et al. Sonographic hepatic-renal ratio as indicator of hepatic steatosis: comparison with 1H magnetic resonance spectrography. Metabolism 2009;58(12):1724–30.

27. Lupsor M., Badea R. Imaging diagnosis and quantification of hepatic stetosis: is it an accepted alternative to needle biopsy? Rom J Gastroenterol 2005;14(4):419–25.