Toward a Digital Twin for Liver Resection Pre-Operative Planning

The liver maintains homeostasis by filtering blood, producing bile, and metabolizing substances. It receives dual blood supply from the hepatic artery and portal vein, distributing blood through sinusoids (liver microvasculature) before draining into the hepatic vein. Cells lining the sinusoids detect haemodynamic changes, initiating liver regeneration after surgical resections. However, liver regeneration ability is limited; excessive tissue removal can lead to complications like small-for-size syndrome (SFSS). SFSS is associated with elevated portal pressure, and we hypothesize that sinusoidal wall shear stress (WSS) above some critical threshold results in cell death which impairs regeneration, leading to liver failure. We use a lumped parameter hydraulic network model to quantify the extent of elevated sinusoidal WSS under different surgical scenarios. Our versatile and computationally efficient approach facilitates future model extensions that will incorporate patient-specific anatomy to improve surgical outcomes for liver resection. By performing computational pre-operative planning, we will help clinicians ensure that WSS levels promote regeneration without causing excess damage that may lead to liver failure.