Regeneration of caudate lobe after living donor liver transplantation: Comparison with a surrogate model of left lobe graft

Regeneration of caudate lobe after living donor liver transplantation: Comparison with a surrogate model of left lobe graft | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Regeneration of caudate lobe after living donor liver transplantation: Comparison with a surrogate model of left lobe graft Yu Saito, Satoru Imura, Yuji Morine, Tetsuya Ikemoto, Shinichiro Yamada, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-34352/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Jan, 2021 Read the published version in The Journal of Medical Investigation → Version 1 posted You are reading this latest preprint version Abstract Background: The aim of this study is to clarify the regeneration of the CL (caudate lobe) without any reconstructions of short hepatic veins (SHVr) after LDLT (living donor liver transplantation) and compare the regeneration of the CL after right hepatectomy (Rt. Hx), as the surrogate model of extended left lobe graft (Ex LLG) with complete SHVr. Methods: Eleven Ex LLGs with CL were included in this study. SHVr was not performed in all cases. The volumetry was performed before, one month and six months after LDLT. Seven patients who underwent Rt. Hx were also included in this study as the surrogate model. Results: In Ex LLGs with CL, t he regeneration rate of the large CL (> 30 ml) was worse than that of small CL (< 30 ml). In the surrogate model, the regeneration rate of the CL was not worse than other segments. However, the regeneration rate of the large CL was also worse than that of small CL even in the presence of complete SHVr. Conclusions: The regeneration of the large CL was worse than that of the small CL regardless of the presence or absence of SHVr, indicating that SHVr in Ex LLG with CL might not be necessary. Surgery General Surgery caudate lobe reconstruction of short hepatic vein living donor liver transplantation Figures Figure 1 Figure 2 Figure 3 Figure 4 Background: As a method of increasing the graft volume in the case of small-for-size living donor grafts (SFSG) in living donor liver transplantation (LDLT), the Shinshu group already reported caudate lobe (CL) transplantation with an extended left lobe graft (Ex LLG) was an innovative and promising method for increasing the graft volume in LDLT 1) . We have also already reported a new technique for left lobe graft harvesting proved a promising approach to gain additional volume 2) . However, little is known about the fate of the CL after transplantation. As a preliminary report regarding the changes in the CL after transplantation, we already reported that regeneration rate of CL was worse than that of left lobe (LL) at one month after LDLT without any reconstructions of short hetiv veins (SHVr), however, the CL volume increased in almost all patients 3) . On the other hand, it was also reported that CL could regenerate proportionally with the LL by complete SHVr 4) . It means that the necessity of SHVr in Ex LLG with CL is still controversial. As our new idea in the present study, we focused on patients after right liver resection (Rt. Hx) for liver tumors. Since CLs of those patients were remnant with SHVs as drainage veins, the patient with Rt. Hx could be used as the surrogate model of Ex LLG with complete SHVr. Accordingly, we herein clarify the regeneration of CL in case of Ex LLG without SHVr after LDLT and compare the regeneration of CL after Rt. Hx, as the surrogate model of Ex LLG with complete SHVr. Methods: Ethical permission This study was approved by The Tokushima University Hospital Ethics Committee and the corresponding regulatory agencies (Tokushima Clinical Trial Management, Approved No 3215) and all the experiments were carried out in accordance with the approved guidelines. Meanwhile, all the patients involved in the study signed the informed consent form and agreed to participate. Patients LDLT; From February, 2005, to March, 2015, eleven Ex LLG with CL were included in this study. All LDLT operations were performed at Tokushima University Hospital. In all cases, SHVr did not be performed. Detailed operative techniques in LDLT were described in previous report 2) . Rt Hx; From December, 2005, to April, 2015, seven patients with initial Rt Hx were included in this study (five patients with liver metastasis of colorectal cancer with no chemotherapy and two patients with liver abscess or hemangioma). These patients were used for the surrogate model of Ex LLG with complete SHVr. CT volumetry 3D-reconstruction of the hepatic vasculature was made using data from a contrast enhanced multi-detector computed tomography (MDCT) and SYNAPSE VINCENT software (Fuji Film Medical Co. Ltd., Tokyo, Japan). The volumetry of each segment was performed by “portal segmentation function” of SYNAPSE VINCENT. The volumetry in LDLT was performed before LDLT from the donors and 1 month and 6 months after LDLT. In the surrogate model, the volumetry was performed as well before operation and 1 month and 6 months after operations. Standard liver volume (SLV), graft volume (GV), and GV/SLV estimation SLV was calculated according to the formula described by Urata et al. 5) . All GV in this study was calculated by volumetry using portal segmentation function. Regeneration rate The regeneration rate was calculated as described below; (Postoperative liver volume (LV) – Preoperative liver volume) / Preoperative liver volume × 100 (%) Statistical Analysis All results were presented as mean ± SD. Comparisons between the two groups were performed using a Chi-square test using statistical software (JMP 8.0.1., SAS Campus Drive, Cary, 27513 NC, USA). A p -value of less than 0.05 was considered statistically significant. Results: Increasing the graft volume with CL The LL graft volume was 456 ± 117 ml at pre LDLT, 1,023 ± 213 ml at one month post LDLT and 1,175 ± 275 ml at six months post LDLT, corresponding to a 40%, 89% and 105% increase respectively in GV/SLV (Table 1). The addition of the CL increased the graft volume by 30 ± 11 ml at one month post LDLT and 28 ± 13 ml at six months post LDLT, corresponding to a 2.6% and 2.5% increase respectively in GV/SLV (Table 1). The regeneration rate of CL in LDLT without SHVr The regeneration rate of CL was 18 ± 42% at one month post LDLT and 0 ± 42% at six months post LDLT (Fig. 1 ). 3 cases showed 5% or more of volume decrease after LDLT, and their preoperative volume were all over 30 ml in volume (data were not shown). Regeneration rate of the small CL (volume ≤ 30 ml) was 39 ± 42% at one month post LDLT and 35 ± 42% at six months post LDLT. On the other hand, regeneration rate of the large CL (volume > 30 ml) was − 27 ± 18% at one month post LDLT and − 54 ± 36% at six months post LDLT (Fig. 2 ). It was suggested that the large CL had worse regeneration than the small CL in Ex LLG without SHVr. The regeneration rate of CL in in the surrogate model with complete SHVr The regeneration rate of CL was 49 ± 62% at one month post operation and 113 ± 93% at six months post operation (Fig. 3 ). Regeneration rate of the small CL (volume ≤ 30 ml) was 56 ± 69% at one month post operation and 164 ± 63% at six months post operation. On the other hand, regeneration rate of the large CL (volume > 30 ml) was 17 ± 3% at one month post operation and 12 ± 8% at six months post operation (Fig. 4 ). It was suggested that the large CL had also worse regeneration than the small CL in the surrogate model with complete SHVr. Discussion: The necessity of SHVr in Ex LLG with CL is still controversial. In the present study, we clarified that the regeneration of CL in case of Ex LLG without SHVr after LDLT and compare the regeneration of CL after Rt. Hx, as the surrogate model of Ex LLG with complete SHVr. It was the first report using the surrogate model of Ex LLG with complete SHVr. Various CL venous reconstruction techniques were described as one of the feasible solutions to overcome SFSG 6–11) . Although the CL volume is small, it is important when the graft volume is critical. We have already showed that the regeneration rate of the transplanted CL and other left lobe graft segments. The regeneration rate of the CL one month after transplantation was smaller (62 ± 24%) than that of other left lobe graft segments (152 ± 35%) 3) . It was already reported that with reconstruction of the inflow 6) or outflow 7) , the regeneration rate of the CL was noted to be equal to or more than that of the other left lobe graft segments. The additional functional volume afforded by CL venous reconstruction might provide an additional safety margin. On the other hand, Mikami K et al 12) reported that the GV/SLV ratio of the whole grafts after LDLT showed no difference regardless of the presence or absence of SHVr. In the present study, in the surrogate model of Ex LLG with complete SHVr, regeneration rate of the CL was not worse than other segments. However, regeneration rate of large CL (volume > 30 ml) had worse than that of the small CL (volume < 30 ml) as well as LDLT without SHVr cases. It was suggested that the size of CL seemed to be important for regeneration as a new finding. As limitations of this study, the present study was a retrospective cohort from a single institution. Although it was necessary to add more patients in the present study, the chance of operation of open Rt Hx with normal liver function have recently decreased. A prospective randomized trial with more patient number will be necessary in the future. Conclusions: Ex LLG with CL was a useful method for increasing the graft volume. The regeneration of the large CL was worse than that of the small CL regardless of the presence or absence of SHVr. It was suggested that SHVr in Ex LLG with CL might be not necessary and the graft size might be important for CL regeneration. List Of Abbreviations small-for-size living donor grafts; SFSG living donor liver transplantation; LDLT caudate lobe; CL extended left lobe graft; Ex LLG left lobe; LL reconstructions of short hetiv vein; SHVr multi-detector computed tomography; MDCT standard liver volume; SLV graft volume; GV liver volume; LV Declarations Ethics approval and consent to participate The study was approved by Tokushima University Hospital ethics committee and with the approval of corresponding regulatory agencies, and all the experiments were carried out in accordance with the approved guidelines (Tokushima Clinical Trial Management System Number; 3215). Meanwhile, all the patients involved in the study signed the informed consent form and agreed to participate. Consent for publication Not applicable Availability of data and materials The current datasets are either deposited in publicly available repositories (where available and appropriate). Competing interests All authors declare that they have no competing interests. Funding All authors declare that they have no sources of funding for the research. Authors' contributions Yu Saito (YS) MD, PhD, FACS: Participated in the research design, performance of the research, data analysis and writing manuscripts. Satoru Imura (SI) MD, PhD, FACS: Participated in the research design and data analysis. Yuji Morine (YM) MD, PhD, FACS: Participated in the research design. Tetsuya Ikemoto (TI) MD, PhD, FACS: Participated in the research design. Shinichiro Yamada (SY) MD, PhD, FACS: Participated in data analysis. Mitsuo Shimada (MS) MD, PhD, FACS: Participated in the critical comments and administrative support. Acknowledgements The present study was reported in the annual congress of European Society for Organ Transplantation (ESOT) 2015 in Brussels. References Miyagawa S, Hashikura Y, Miwa S, Ikegami T, Urata K, Terada M, et al. Concomitant caudate lobe resection as an option for donor hepatectomy in adult living related liver transplantation. Transplantation. 1998;66:661–3. Imura S, Shimada M, Miyake K, Ikemoto T, Morine Y, Yoshizumi T. A new technique to acquire additional liver volume for left lobe graft in living donor liver transplantation. Hepatogastroenterology. 2008;55(85):1206–10. Ikegami T, Nishizaki T, Yanaga K, Shimada M, Kakizoe S, Nomoto K, et al. Changes in the caudate lobe that is transplanted with extended left lobe liver graft from living donors. Surgery. 2001;129(1):86–90. Sugawara Y, Makuuchi M, Takayama T. Left liver plus caudate lobe graft with complete revascularization. Surgery. 2002;132(5):904–5. author reply 905-6. Kawasaki S, Makuuchi M, Matsunami H, Hashikura Y, Ikegami T, Chisuwa H, et al. Preoperative measurement of Segmental liver volume of donors for living related liver transplantation. Hepatology. 1993;18:1115–20. Kokudo N, Sugawara Y, Kaneko J, Imamura H, Sano K, Makuuchi M. Reconstruction of isolated caudate portal vein in left liver graft. Liver Transpl. 2004;10:1163. Hashimoto T, Sugawara Y, Tamura S, Kaneko J, Motomura N, Takamoto S, et al. One orifice vein reconstruction in left liver plus caudate lobe grafts. Transplantation. 2007;83:225. Takayama T, Makuuchi M, Kubota K, Sano K, Harihara Y, Kawarasaki H. Living-related transplantation of left liver plus caudate lobe. J Am Coll Surg. 2000;190:635. Sugawara Y, Makuuchi M, Kaneko J, Ohkubo T, Matsui Y, Imamura H. New venoplasty technique for the left liver plus caudate lobe in living donor liver transplantation. Liver Transpl. 2002;8:76. Hwang S, Lee SG, Ha TY, Ahn CS, Park KM, Kim KH, et al. Simplified standardized technique for living donor liver transplantation using left liver graft plus caudate lobe. Liver Transpl. 2004;10:1398. Yamazaki S, Takayama T, Inoue K, Higaki T, Makuuchi M. Interposition of autologous portal vein graft in left liver transplantation. Liver Transpl. 2005;11:1615. Mikami K, Matsuoka N, Maekawa T, Yamauchi Y, Noritomi T, Hoshino S, et al. Impact of short hepatic vein reconstruction in living donor adult liver transplantation using a left liver plus caudate lobe graft. Asian J Surg. 2010;33:8–1. Cite Share Download PDF Status: Published Journal Publication published 01 Jan, 2021 Read the published version in The Journal of Medical Investigation → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-34352","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":658827,"identity":"29f1fe9b-d386-42f8-9d7f-20327b14752d","order_by":0,"name":"Yu Saito","email":"data:image/png;base64,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","orcid":"","institution":"Tokushima University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"Saito","suffix":""},{"id":658828,"identity":"6288f1e3-52a6-4bfd-bd0a-4328ba74f6fc","order_by":1,"name":"Satoru Imura","email":"","orcid":"","institution":"Department of Surgery, Tokushima University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Satoru","middleName":"","lastName":"Imura","suffix":""},{"id":658829,"identity":"1f3630a9-ff2d-4b4b-8378-6454eb80402a","order_by":2,"name":"Yuji Morine","email":"","orcid":"","institution":"Department of Surgery, Tokushima University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yuji","middleName":"","lastName":"Morine","suffix":""},{"id":658830,"identity":"04d3d725-04b2-4642-bd7b-a42af34a2425","order_by":3,"name":"Tetsuya Ikemoto","email":"","orcid":"","institution":"Department of Surgery, Tokushima University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tetsuya","middleName":"","lastName":"Ikemoto","suffix":""},{"id":658831,"identity":"9be656cd-f9a3-41fd-a9e2-26c3dabfa886","order_by":4,"name":"Shinichiro Yamada","email":"","orcid":"","institution":"Department of Surgery, Tokushima University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shinichiro","middleName":"","lastName":"Yamada","suffix":""},{"id":658832,"identity":"9c3779c9-4ad4-4b3c-a6e0-d8bd3e9194b6","order_by":5,"name":"Mitsuo Shimada","email":"","orcid":"","institution":"Department of Surgery, Tokushima University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mitsuo","middleName":"","lastName":"Shimada","suffix":""}],"badges":[],"createdAt":"2020-06-08 22:18:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-34352/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-34352/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.2152/jmi.68.330","type":"published","date":"2021-01-01T22:55:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":1319230,"identity":"aeb8eeb3-188c-44e0-935a-b77a8c549736","added_by":"auto","created_at":"2020-06-12 20:40:30","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":23204,"visible":true,"origin":"","legend":"Regeneration rate of CL in LDLT without SHVr\n The regeneration rate of CL was 18 ± 42 % at one month post LDLT and 0 ±\n 42 % at six months post LDLT.","description":"","filename":"Figure1.JPG","url":"https://assets-eu.researchsquare.com/files/rs-34352/v1/Figure1.JPG"},{"id":1319231,"identity":"fd029b28-9755-4fb5-a3ce-c6b16899c89d","added_by":"auto","created_at":"2020-06-12 20:40:30","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":32131,"visible":true,"origin":"","legend":"Comparison of the regeneration between small and large CL in LDLT without SHVr\n Regeneration rate of the small CL (volume \u003c 30ml) was 39 ± 42 % at one month\n post LDLT and 35 ± 42 % at six months post LDLT. On the other hand,\n regeneration rate of the large CL (volume \u003e 30ml) was -27 ± 18 % at one month\n post LDLT and -54 ± 36% at six months post LDLT.","description":"","filename":"Figure2.JPG","url":"https://assets-eu.researchsquare.com/files/rs-34352/v1/Figure2.JPG"},{"id":1319232,"identity":"6ee680e7-59c8-4867-8782-84d6db1dd6f4","added_by":"auto","created_at":"2020-06-12 20:40:30","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":24036,"visible":true,"origin":"","legend":"Regeneration rate of CL in the surrogate model with SHVr\n The regeneration rate of CL was 49 ± 62% at one month post operation and 113 ±\n 93% at six months post operation.","description":"","filename":"Figure3.JPG","url":"https://assets-eu.researchsquare.com/files/rs-34352/v1/Figure3.JPG"},{"id":1319233,"identity":"6932bf43-f0eb-452a-9e30-ac448004e59b","added_by":"auto","created_at":"2020-06-12 20:40:30","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":28885,"visible":true,"origin":"","legend":"Comparison of the regeneration between small and large CL in the surrogate model with SHVr\n Regeneration rate of the small CL (volume \u003c 30ml) was 56 ± 69 % at one month post operation and 164 ± 63 % at six months post operation. On the other hand, regeneration rate of the large CL (volume \u003e 30ml) was 17 ± 3 % at one month post operation and 12 ± 8% at six months post operation.","description":"","filename":"Figure4.JPG","url":"https://assets-eu.researchsquare.com/files/rs-34352/v1/Figure4.JPG"},{"id":15416448,"identity":"74a0bca5-99bd-4c38-89b7-f0ee48bcd500","added_by":"auto","created_at":"2021-11-10 22:55:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":430568,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-34352/v1/ba7c13f4-5b3a-4e07-abf5-85303e8c473b.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eRegeneration of caudate lobe after living donor liver transplantation: Comparison with a surrogate model of left lobe graft\u003c/p\u003e","fulltext":[{"header":"Background:","content":" \u003cp\u003eAs a method of increasing the graft volume in the case of small-for-size living donor grafts (SFSG) in living donor liver transplantation (LDLT), the Shinshu group already reported caudate lobe (CL) transplantation with an extended left lobe graft (Ex LLG) was an innovative and promising method for increasing the graft volume in LDLT \u003csup\u003e1)\u003c/sup\u003e. We have also already reported a new technique for left lobe graft harvesting proved a promising approach to gain additional volume \u003csup\u003e2)\u003c/sup\u003e. However, little is known about the fate of the CL after transplantation. As a preliminary report regarding the changes in the CL after transplantation, we already reported that regeneration rate of CL was worse than that of left lobe (LL) at one month after LDLT without any reconstructions of short hetiv veins (SHVr), however, the CL volume increased in almost all patients \u003csup\u003e3)\u003c/sup\u003e. On the other hand, it was also reported that CL could regenerate proportionally with the LL by complete SHVr \u003csup\u003e4)\u003c/sup\u003e. It means that the necessity of SHVr in Ex LLG with CL is still controversial.\u003c/p\u003e \u003cp\u003eAs our new idea in the present study, we focused on patients after right liver resection (Rt. Hx) for liver tumors. Since CLs of those patients were remnant with SHVs as drainage veins, the patient with Rt. Hx could be used as the surrogate model of Ex LLG with complete SHVr.\u003c/p\u003e \u003cp\u003eAccordingly, we herein clarify the regeneration of CL in case of Ex LLG without SHVr after LDLT and compare the regeneration of CL after Rt. Hx, as the surrogate model of Ex LLG with complete SHVr.\u003c/p\u003e "},{"header":"Methods:","content":" \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEthical permission\u003c/h2\u003e \u003cp\u003eThis study was approved by The Tokushima University Hospital Ethics Committee and the corresponding regulatory agencies (Tokushima Clinical Trial Management, Approved No 3215) and all the experiments were carried out in accordance with the approved guidelines. Meanwhile, all the patients involved in the study signed the informed consent form and agreed to participate.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003e \u003cb\u003eLDLT;\u003c/b\u003e From February, 2005, to March, 2015, eleven Ex LLG with CL were included in this study. All LDLT operations were performed at Tokushima University Hospital. In all cases, SHVr did not be performed. Detailed operative techniques in LDLT were described in previous report \u003csup\u003e2)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cb\u003eRt Hx;\u003c/b\u003e From December, 2005, to April, 2015, seven patients with initial Rt Hx were included in this study (five patients with liver metastasis of colorectal cancer with no chemotherapy and two patients with liver abscess or hemangioma). These patients were used for the surrogate model of Ex LLG with complete SHVr.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eCT volumetry\u003c/h2\u003e \u003cp\u003e3D-reconstruction of the hepatic vasculature was made using data from a contrast enhanced multi-detector computed tomography (MDCT) and SYNAPSE VINCENT software (Fuji Film Medical Co. Ltd., Tokyo, Japan). The volumetry of each segment was performed by \u0026ldquo;portal segmentation function\u0026rdquo; of SYNAPSE VINCENT. The volumetry in LDLT was performed before LDLT from the donors and 1 month and 6 months after LDLT. In the surrogate model, the volumetry was performed as well before operation and 1 month and 6 months after operations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStandard liver volume (SLV), graft volume (GV), and GV/SLV estimation\u003c/h2\u003e \u003cp\u003eSLV was calculated according to the formula described by Urata et al. \u003csup\u003e5)\u003c/sup\u003e. All GV in this study was calculated by volumetry using portal segmentation function.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eRegeneration rate\u003c/h2\u003e \u003cp\u003eThe regeneration rate was calculated as described below; (Postoperative liver volume (LV) \u0026ndash; Preoperative liver volume) / Preoperative liver volume\u0026thinsp;\u0026times;\u0026thinsp;100 (%)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAll results were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. Comparisons between the two groups were performed using a Chi-square test using statistical software (JMP 8.0.1., SAS Campus Drive, Cary, 27513 NC, USA). A \u003cem\u003ep\u003c/em\u003e-value of less than 0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e "},{"header":"Results:","content":" \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eIncreasing the graft volume with CL\u003c/h2\u003e \u003cp\u003eThe LL graft volume was 456\u0026thinsp;\u0026plusmn;\u0026thinsp;117\u0026nbsp;ml at pre LDLT, 1,023\u0026thinsp;\u0026plusmn;\u0026thinsp;213\u0026nbsp;ml at one month post LDLT and 1,175\u0026thinsp;\u0026plusmn;\u0026thinsp;275\u0026nbsp;ml at six months post LDLT, corresponding to a 40%, 89% and 105% increase respectively in GV/SLV (Table\u0026nbsp;1).\u003c/p\u003e \u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\u003cp\u003eThe addition of the CL increased the graft volume by 30\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u0026nbsp;ml at one month post LDLT and 28\u0026thinsp;\u0026plusmn;\u0026thinsp;13\u0026nbsp;ml at six months post LDLT, corresponding to a 2.6% and 2.5% increase respectively in GV/SLV (Table\u0026nbsp;1).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eThe regeneration rate of CL in LDLT without SHVr\u003c/h2\u003e \u003cp\u003eThe regeneration rate of CL was 18\u0026thinsp;\u0026plusmn;\u0026thinsp;42% at one month post LDLT and 0\u0026thinsp;\u0026plusmn;\u0026thinsp;42% at six months post LDLT (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). 3 cases showed 5% or more of volume decrease after LDLT, and their preoperative volume were all over 30\u0026nbsp;ml in volume (data were not shown). Regeneration rate of the small CL (volume\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;30\u0026nbsp;ml) was 39\u0026thinsp;\u0026plusmn;\u0026thinsp;42% at one month post LDLT and 35\u0026thinsp;\u0026plusmn;\u0026thinsp;42% at six months post LDLT. On the other hand, regeneration rate of the large CL (volume\u0026thinsp;\u0026gt;\u0026thinsp;30\u0026nbsp;ml) was \u0026minus;\u0026thinsp;27\u0026thinsp;\u0026plusmn;\u0026thinsp;18% at one month post LDLT and \u0026minus;\u0026thinsp;54\u0026thinsp;\u0026plusmn;\u0026thinsp;36% at six months post LDLT (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). It was suggested that the large CL had worse regeneration than the small CL in Ex LLG without SHVr.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eThe regeneration rate of CL in in the surrogate model with complete SHVr\u003c/h2\u003e \u003cp\u003eThe regeneration rate of CL was 49\u0026thinsp;\u0026plusmn;\u0026thinsp;62% at one month post operation and 113\u0026thinsp;\u0026plusmn;\u0026thinsp;93% at six months post operation (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Regeneration rate of the small CL (volume\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;30\u0026nbsp;ml) was 56\u0026thinsp;\u0026plusmn;\u0026thinsp;69% at one month post operation and 164\u0026thinsp;\u0026plusmn;\u0026thinsp;63% at six months post operation. On the other hand, regeneration rate of the large CL (volume\u0026thinsp;\u0026gt;\u0026thinsp;30\u0026nbsp;ml) was 17\u0026thinsp;\u0026plusmn;\u0026thinsp;3% at one month post operation and 12\u0026thinsp;\u0026plusmn;\u0026thinsp;8% at six months post operation (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). It was suggested that the large CL had also worse regeneration than the small CL in the surrogate model with complete SHVr.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e "},{"header":"Discussion:","content":" \u003cp\u003eThe necessity of SHVr in Ex LLG with CL is still controversial. In the present study, we clarified that the regeneration of CL in case of Ex LLG without SHVr after LDLT and compare the regeneration of CL after Rt. Hx, as the surrogate model of Ex LLG with complete SHVr. It was the first report using the surrogate model of Ex LLG with complete SHVr.\u003c/p\u003e \u003cp\u003eVarious CL venous reconstruction techniques were described as one of the feasible solutions to overcome SFSG \u003csup\u003e6\u0026ndash;11)\u003c/sup\u003e. Although the CL volume is small, it is important when the graft volume is critical. We have already showed that the regeneration rate of the transplanted CL and other left lobe graft segments. The regeneration rate of the CL one month after transplantation was smaller (62\u0026thinsp;\u0026plusmn;\u0026thinsp;24%) than that of other left lobe graft segments (152\u0026thinsp;\u0026plusmn;\u0026thinsp;35%) \u003csup\u003e3)\u003c/sup\u003e. It was already reported that with reconstruction of the inflow \u003csup\u003e6)\u003c/sup\u003e or outflow \u003csup\u003e7)\u003c/sup\u003e, the regeneration rate of the CL was noted to be equal to or more than that of the other left lobe graft segments. The additional functional volume afforded by CL venous reconstruction might provide an additional safety margin.\u003c/p\u003e \u003cp\u003eOn the other hand, Mikami K et al \u003csup\u003e12)\u003c/sup\u003e reported that the GV/SLV ratio of the whole grafts after LDLT showed no difference regardless of the presence or absence of SHVr. In the present study, in the surrogate model of Ex LLG with complete SHVr, regeneration rate of the CL was not worse than other segments. However, regeneration rate of large CL (volume\u0026thinsp;\u0026gt;\u0026thinsp;30\u0026nbsp;ml) had worse than that of the small CL (volume\u0026thinsp;\u0026lt;\u0026thinsp;30\u0026nbsp;ml) as well as LDLT without SHVr cases. It was suggested that the size of CL seemed to be important for regeneration as a new finding.\u003c/p\u003e \u003cp\u003eAs limitations of this study, the present study was a retrospective cohort from a single institution. Although it was necessary to add more patients in the present study, the chance of operation of open Rt Hx with normal liver function have recently decreased. A prospective randomized trial with more patient number will be necessary in the future.\u003c/p\u003e "},{"header":"Conclusions:","content":" \u003cp\u003eEx LLG with CL was a useful method for increasing the graft volume. The regeneration of the large CL was worse than that of the small CL regardless of the presence or absence of SHVr. It was suggested that SHVr in Ex LLG with CL might be not necessary and the graft size might be important for CL regeneration.\u003c/p\u003e "},{"header":"List Of Abbreviations","content":" \u003cp\u003esmall-for-size living donor grafts; SFSG\u003c/p\u003e \u003cp\u003eliving donor liver transplantation; LDLT\u003c/p\u003e \u003cp\u003ecaudate lobe; CL\u003c/p\u003e \u003cp\u003eextended left lobe graft; Ex LLG\u003c/p\u003e \u003cp\u003eleft lobe; LL\u003c/p\u003e \u003cp\u003ereconstructions of short hetiv vein; SHVr\u003c/p\u003e \u003cp\u003emulti-detector computed tomography; MDCT\u003c/p\u003e \u003cp\u003estandard liver volume; SLV\u003c/p\u003e \u003cp\u003egraft volume; GV\u003c/p\u003e \u003cp\u003eliver volume; LV\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by Tokushima University Hospital ethics committee and with the approval of corresponding regulatory agencies, and all the experiments were carried out in accordance with the approved guidelines (Tokushima Clinical Trial Management System Number; 3215). Meanwhile, all the patients involved in the study signed the informed consent form and agreed to participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe current datasets are either deposited in publicly available repositories (where available and appropriate).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare that they have no sources of funding for the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYu Saito (YS) MD, PhD, FACS: Participated in the research design, performance of the research, data analysis and writing manuscripts.\u003c/p\u003e\n\u003cp\u003eSatoru Imura (SI) MD, PhD, FACS: Participated in the research design and data analysis.\u003c/p\u003e\n\u003cp\u003eYuji Morine (YM) MD, PhD, FACS: Participated in the research design.\u003c/p\u003e\n\u003cp\u003eTetsuya Ikemoto (TI) MD, PhD, FACS: Participated in the research design.\u003c/p\u003e\n\u003cp\u003eShinichiro Yamada (SY) MD, PhD, FACS: Participated in data analysis.\u003c/p\u003e\n\u003cp\u003eMitsuo Shimada (MS) MD, PhD, FACS: Participated in the critical comments and administrative support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study was reported in the annual congress of European Society for Organ Transplantation (ESOT) 2015 in Brussels.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e \u003cspan\u003eMiyagawa S, Hashikura Y, Miwa S, Ikegami T, Urata K, Terada M, et al. Concomitant caudate lobe resection as an option for donor hepatectomy in adult living related liver transplantation. Transplantation. 1998;66:661\u0026ndash;3.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eImura S, Shimada M, Miyake K, Ikemoto T, Morine Y, Yoshizumi T. A new technique to acquire additional liver volume for left lobe graft in living donor liver transplantation. Hepatogastroenterology. 2008;55(85):1206\u0026ndash;10.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eIkegami T, Nishizaki T, Yanaga K, Shimada M, Kakizoe S, Nomoto K, et al. Changes in the caudate lobe that is transplanted with extended left lobe liver graft from living donors. Surgery. 2001;129(1):86\u0026ndash;90.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eSugawara Y, Makuuchi M, Takayama T. Left liver plus caudate lobe graft with complete revascularization. Surgery. 2002;132(5):904\u0026ndash;5. author reply 905-6.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eKawasaki S, Makuuchi M, Matsunami H, Hashikura Y, Ikegami T, Chisuwa H, et al. Preoperative measurement of Segmental liver volume of donors for living related liver transplantation. Hepatology. 1993;18:1115\u0026ndash;20.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eKokudo N, Sugawara Y, Kaneko J, Imamura H, Sano K, Makuuchi M. Reconstruction of isolated caudate portal vein in left liver graft. Liver Transpl. 2004;10:1163.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eHashimoto T, Sugawara Y, Tamura S, Kaneko J, Motomura N, Takamoto S, et al. One orifice vein reconstruction in left liver plus caudate lobe grafts. Transplantation. 2007;83:225.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eTakayama T, Makuuchi M, Kubota K, Sano K, Harihara Y, Kawarasaki H. Living-related transplantation of left liver plus caudate lobe. J Am Coll Surg. 2000;190:635.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eSugawara Y, Makuuchi M, Kaneko J, Ohkubo T, Matsui Y, Imamura H. New venoplasty technique for the left liver plus caudate lobe in living donor liver transplantation. Liver Transpl. 2002;8:76.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eHwang S, Lee SG, Ha TY, Ahn CS, Park KM, Kim KH, et al. Simplified standardized technique for living donor liver transplantation using left liver graft plus caudate lobe. Liver Transpl. 2004;10:1398.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eYamazaki S, Takayama T, Inoue K, Higaki T, Makuuchi M. Interposition of autologous portal vein graft in left liver transplantation. Liver Transpl. 2005;11:1615.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eMikami K, Matsuoka N, Maekawa T, Yamauchi Y, Noritomi T, Hoshino S, et al. Impact of short hepatic vein reconstruction in living donor adult liver transplantation using a left liver plus caudate lobe graft. Asian J Surg. 2010;33:8\u0026ndash;1.\u003c/span\u003e \u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"caudate lobe, reconstruction of short hepatic vein, living donor liver transplantation","lastPublishedDoi":"10.21203/rs.3.rs-34352/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-34352/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eThe aim of this study is to clarify the regeneration of the CL (caudate lobe) without any reconstructions of short hepatic veins (SHVr) after LDLT (living donor liver transplantation) and compare the regeneration of the CL after right hepatectomy (Rt. Hx), as the surrogate model of extended left lobe graft (Ex LLG) with complete SHVr.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eEleven Ex LLGs with CL were included in this study. SHVr was not performed in all cases. The volumetry was performed before, one month and six months after LDLT. Seven patients who underwent Rt. Hx were also included in this study as the surrogate model.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eIn Ex LLGs with CL, \u003cb\u003et\u003c/b\u003ehe regeneration rate of the large CL (\u0026gt;\u0026thinsp;30\u0026nbsp;ml) was worse than that of small CL (\u0026lt;\u0026thinsp;30\u0026nbsp;ml). In the surrogate model, the regeneration rate of the CL was not worse than other segments. However, the regeneration rate of the large CL was also worse than that of small CL even in the presence of complete SHVr.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eThe regeneration of the large CL was worse than that of the small CL regardless of the presence or absence of SHVr, indicating that SHVr in Ex LLG with CL might not be necessary.\u003c/p\u003e","manuscriptTitle":"Regeneration of caudate lobe after living donor liver transplantation: Comparison with a surrogate model of left lobe graft","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-06-12 20:40:29","doi":"10.21203/rs.3.rs-34352/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fe065a82-22fc-45b9-8db9-2fe131415826","owner":[],"postedDate":"June 12th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":118688,"name":"Surgery"},{"id":118689,"name":"General Surgery"}],"tags":[],"updatedAt":"2021-11-10T22:55:50+00:00","versionOfRecord":{"articleIdentity":"rs-34352","link":"https://doi.org/10.2152/jmi.68.330","journal":{"identity":"the-journal-of-medical-investigation","isVorOnly":true,"title":"The Journal of Medical Investigation"},"publishedOn":"2021-01-01 22:55:50","publishedOnDateReadable":"January 1st, 2021"},"versionCreatedAt":"2020-06-12 20:40:29","video":"","vorDoi":"10.2152/jmi.68.330","vorDoiUrl":"https://doi.org/10.2152/jmi.68.330","workflowStages":[]},"version":"v1","identity":"rs-34352","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-34352","identity":"rs-34352","version":["v1"]},"buildId":"rHA-KDH7Qsr4HCuvH75dn","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}