Pre-Clinical Validation of a Digital Twin to Guide Pre-Operative Liver Resection

The liver receives dual blood supply from the hepatic artery and portal vein, which branch through multiple generations before converging at the portal triad. From each portal triad, blood flows through the liver sinusoids (i.e., microvasculature) and drains into the hepatic vein. Cells lining the sinusoids sense and transmit hemodynamic changes to neighboring cells, triggering liver regeneration after surgical resections. However, the liver's regenerative capacity is finite; excessive tissue removal can lead to complications such as small-for-size syndrome, a condition associated with elevated portal pressure and sinusoidal wall shear stress (WSS). We hypothesize that sinusoidal WSS exceeding a critical threshold results in cell death, which impairs regeneration and may lead to liver failure. To test this hypothesis, we have developed a digital twin of the human liver that can be parameterized with patient-specific vessel anatomy and measured pressures and/or volume flow rates to predict sinusoidal WSS. We will present pre-clinical validation of this model based on normothermic machine perfusion of a resected porcine liver and discuss the methods used to estimate unknown model parameters. Future work will test whether excessive sinusoidal WSS is deleterious to liver regeneration. Ultimately, our approach can be extended to guide patient-specific pre-operative planning for improving liver resection outcomes by predicting WSS levels that promote regeneration and reduce liver failure risk.