PMC8842677_01
PMC8842677_02
Estimated hepatic and splenic volumes of the recipient and photographs of the operating field. (a) Calculated hepatic volume was 905 ml (volume of planned preserved right hemi-liver was 270 ml), and splenic volume was 1,445 ml (volume of designed preserved upper pole was 503 ml; (b) remnant right hemi-liver and large varicose veins (black arrow); (c) hepatic artery and portal vein to auxiliary partial graft; (d) ischemic demarcation line on spleen (blue arrow) during simultaneous subtotal splenectomy; (e) native remnant liver (R), partial liver graft (G) and residual spleen (S).
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F1
The calculated volume of the whole spleen and the designed preserved upper pole of the spleen were 1,445 and 503 ml, respectively (Figure 1a). The recipient underwent APOLT with preservation of the native right lobe liver (Figure 1b). The graft's left hepatic artery was anastomosed to the recipient's left hepatic artery (Figure 1c). About 70% of the splenic volume was resected (Figure 1d), and the final graft PVP was 14 mmHg. Biliary anastomosis was performed between the graft left bile duct and the recipient left bile duct (Figure 1e).
Overview of total bilirubin (mg/dl), international normalized ratio (INR), aspartate aminotransferase (AST, U/L), alanine aminotransferase (ALT, U/L), platelet (PLT, 109/L) count, and white blood cell (WBC, 109/L) count during follow-up.
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F2
Then anticoagulation using warfarin was added to maintain INR 1.5-2.0 until postoperative month 3 (Figure 2). Apart from massive ascites production, the postoperative hospital course was uneventful, and graft function recovered rapidly (Figure 2). The platelet and leukocyte counts increased immediately during the perioperative period and remained in the normal ranges during long-term follow-up (Figure 2). To date (35.3 months post-transplant), the patient's graft function is good, and peripheral platelet and leukocyte counts remain in the normal ranges (Figure 2).
Pre- and postoperative imaging. (A) Changes in CT-simulated volume of the native residual liver, graft, and spleen throughout follow-up; (B) representative abdominal CT images (R, liver remnant; G, graft; S, spleen); (C) Tc-99 m hepatobiliary scintigraphy on post-transplant day 14 and 712 (left liver graft: right native liver = 88%: 12 and 97.9%: 2.1%, respectively).
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F3
The results showed gradually increased volume and enhanced function of the liver graft (Figure 3). The volume of the remnant spleen was also monitored, indicating no occurrence of splenic regrowth (Figure 3A).