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Quantitative Analysis of the Human Intrahepatic Biliary System Using a 3D Model: Implications for Adult-to-Adult Living Donor Liver Transplantation Surgery

Abouzaid, Kamal A
http://rave.ohiolink.edu/etdc/view?acc_num=osu1420736290

Abstract Details

2015, Doctor of Philosophy, Ohio State University, Anatomy.
Despite the fact that liver transplantation procedures have achieved remarkable success, the shortage of donor liver grafts prevents these procedures from realizing their full potential. To address the shortage of organs from deceased donors, living donor liver transplantation (LDLT) has become a widely accepted option, particularly in countries where using organs from brain-dead individuals is restricted. In the United States, with an ever-growing number of patients on the waiting list for an organ donation, the human costs of prolonged waiting are substantial. Hence, expansion of the use of LDLT is essential. However, the number of live donations has declined from a peak in 2001 to less than half that number in 2012. This decline might be explained by a few catastrophic and well-publicized donor events, and the negative impact of these events on both the transplantation community and the public. Donor morbidity remains a major concern in LDLT. Various reports have shown that minimal donor risk coupled with maximum recipient benefit, can be achieved by using the left hepatic lobe as an explant. However, in the United States, it is the right lobe graft that is used most often in adult-to adult LDLT. Regardless of whether the right or the left liver lobe is used, the most common cause of post-operative morbidity in the donor, and morbidity and mortality in the recipient is biliary complications. The high rate of post-transplantation biliary complications and the lack of efficient imaging methods for pre-operative assessment of the intrahepatic biliary system of the living donor liver, suggest that anatomical studies at the experimental level are needed. The purpose of this study is to determine if there are anatomical explanations for why the left liver lobe has been used so successfully as an explant. Contrast enhanced computed tomography imaging of cadaveric livers, and subsequent 3D modeling was used to define the relationship between biliary volume and liver volume. Results suggest that the high success rate of LDLT using the left lobe and left lateral section might be explained by the fact that they contain more bile ducts, based on liver volume, than the right lobe, and correspondingly, more regenerative capacity, since bile ducts contains the stem cell niche of the liver. In addition, the anatomical variations of the biliary system were studied, and the number and diameter of ducts crossing the plane of hepatic transection were evaluated and related to the various anatomic variations seen in formation of the major biliary ducts. This analysis of the bile ducts crossing the resection plane suggests that certain patterns of crossing ducts can be correlated with specific variations in formation of the main biliary vessels, information that will make the surgical resection of the liver explant a more predictable procedure. Together, these results concerning biliary volume and biliary duct anatomy may help motivate the transplantation community in the United States to expand use of the LDLT procedure.
Robert DePhilip (Advisor)
147 p.
Anatomy and Physiology; Surgery
Adult-to-Adult living donor liver transplantation; Biliary complications in living donor liver transplantation; Quantitative analysis of the biliary system; Biliary variations; OsiriX 3D Modeling; Intrahepatic biliary volume; Liver volume; Liver resection

Recommended Citations

Citations

  • Abouzaid, K. A. (2015). Quantitative Analysis of the Human Intrahepatic Biliary System Using a 3D Model: Implications for Adult-to-Adult Living Donor Liver Transplantation Surgery [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1420736290

    APA Style (7th edition)

  • Abouzaid, Kamal. Quantitative Analysis of the Human Intrahepatic Biliary System Using a 3D Model: Implications for Adult-to-Adult Living Donor Liver Transplantation Surgery. 2015. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1420736290.

    MLA Style (8th edition)

  • Abouzaid, Kamal. "Quantitative Analysis of the Human Intrahepatic Biliary System Using a 3D Model: Implications for Adult-to-Adult Living Donor Liver Transplantation Surgery." Doctoral dissertation, Ohio State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=osu1420736290

    Chicago Manual of Style (17th edition)

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This open access ETD is published by The Ohio State University and OhioLINK.