Despite refinements in surgical techniques for liver transplantation, liver size disparity remains one of the most common problems in pediatric patients. Optimal liver graft size remains unknown and the volume of diseased liver in the recipient is not indicative of the volume (standard liver volume [LV]) optimal for the recipient's metabolic demands. To establish a formula for calculating the standard LV in the pediatric and adult populations for liver transplantation, whole LVs were measured using computed tomography (CT) in 96 patients (65 pediatric and 31 adolescent or adult subjects) with normal liver whose disease conditions did not seem to affect body weight (BW) or LV. In the 96 subjects, the ratio of estimated LV to BW decreased gradually as age increased until approximately 16 years, when it started to level off. On the other hand, there seemed to be a directly proportional relationship between the estimated LV in vivo and body surface area (BSA) (r = .981; r2 = .962; P < .0001) in the subjects as a whole, and the formula, LV (mL) = 706.2 x BSA (m2) + 2.4, was established from the measured data by simple regression analysis. Another predicting equation, LV (mL) = 2.223 x BW (kg)0.426 x body height (BH) (cm)0.682, was produced by multiple regression analysis (r2 = .969; P < .0001). Considering its simplicity of use, we adopted the first formula for predicting standard LV in an individual patient.

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ObjectiveTo evaluate the outcome of living related liver transplantation (LRLT) in adult patients and to assess graft size disparity and graft regeneration. Summary Background DataAlthough LRLT has been accepted as an optional life-saving procedure for pediatric patients with end-stage liver disease, the feasibility of LRLT for adult patients has not been reported with reference to a clinical series. MethodsAdult-to-adult LRLT was performed using whole left lobar grafts in 13 patients (5 with primary biliary cirrhosis, 6 with familial amyloid polyneuropathy, 1 with biliary atresia, and 1 with citrullinemia). The 13 donors comprised 5 husbands, 3 sons, 2 sisters, 2 fathers, and 1 mother. The ratio of the graft volume to standard liver volume (GV/SV ratio) was calculated for use as a parameter of graft size disparity. ResultsAlthough the liver graft was markedly small for size (GV/SV ratio 32%-59% at the time of LRLT), none of the 13 patients developed postoperative liver failure. Eleven of the patients are still alive and well with satisfactory graft function 2 to 35 months after LRLT. Graft liver volume increased rapidly after LRLT and approximated the standard liver volume with time. ConclusionsOur LRLT program for adult patients has produced good results. LRLT in adults can be indicated for selected donor-recipient combinations.Since Broelsch et al.' reported the first successful series in Western countries and also in Japan.2-8 The initial of living related liver transplantations (LRLTs), the use series of LRLTs reported by Broelsch et al. was limited of this innovative surgical treatment has steadily increased to infants with a body weight < 15 kg, and only the left lateral segment of the donor liver was used as a graft.

The state of venous congestion in the right liver graft can be correctly assessed by the temporary arterial clamping method and intraoperative Doppler ultrasonography. If the venocongestive area is demonstrated to be so large that the graft volume excluding this area is thought to be insufficient for postoperative metabolic demand, venous reconstruction is recommended.