A formula to calculate the standard liver volume in children and its application in pediatric liver transplantation

Abstract

SummaryDue to a lack of available size-matched liver grafts from children, most pediatric recipients are transplanted with technical variant grafts from adult donors. Size requirements for these grafts are not well defined, and consequences of mismatched graft sizes in pediatric liver transplantation are not known. Existing formulas for calculation of a standard liver volume are mostly derived from adults disregarding the age-related percentual liver weight changes in children. In this study, we aimed to establish a formula for general use in children to calculate the standard liver volume. In a second step, the formula was applied in pediatric patients undergoing liver transplantation at our institution between 2000 and 2010 (n = 377). Analysis of a large number (n = 388) of autopsy data from children by regression analysis revealed a best fit for two formulas: "Formula 1," children 0 to ≤1 year (n = 246): standard liver volume [ml] = À143.062973 + 4.274603051 * body length [cm] + 14.78817631 * body weight [kg]; "Formula 2," children >1 to <16 years (n = 142): standard liver volume [ml] = À20.2472281 + 3.339056437 * body length [cm] + 13.11312561 * body weight [kg]. In comparison with children receiving size-matched organs, we found an elevated risk of liver graft failure in children transplanted with a small-for-size graft, whereas large-for-size organs seem to have no negative impact.

Utility of neonatal donors in pediatric liver transplantation: A single‐center experience

“…Six children in group 3 received large‐size grafts (GRWR >4%), these large grafts could fit well into the abdomen, and the recipients achieved equal outcome with other recipients who received size‐matched organs. Thus, our data supported the previous report that large‐for‐size transplantation in children did not influence the postoperative outcomes …”

“…Thus, our data supported the previous report that large-for-size transplantation in children did not influence the postoperative outcomes. 32 In spite of the fact that neonatal (group 1) and infant (group 2) grafts seemed to have higher rate of SFSS, the recipients in these two groups showed favorable outcome in acute rejection, and the recipients in group 3 exhibited significantly higher rate of acute rejection compared with the combination of groups 1 and 2 in our study. It has long been claimed that immune tolerance is more likely to be induced in children due to the immatureness of immune system.…”

Associating liver partition with portal vein ligation and staged hepatectomy (ALPPS) for the treatment of liver tumors in children

“…When considering the standard liver volume using the formula proposed by Herden et al [13], we found an estimated standard liver volume ranging from 460.75 cc to 1089.76 cc, with a median of 876.37 cc, a mean ± sd of 820.81 ± 245.69 cc. The percentage of future liver remnant (FLR) of total liver volume (TLV) ranged from 14.7% to 39.3%, with a median of 25.5%, a mean ± sd of 25.5 ± 8%.…”

Growth of liver allografts over time in pediatric transplant recipients

“… 0 to ≤1 year of age: SLV (mL) = −143.062973 + 4.274603051 × height (cm) + 14.78817631 × weight (kg) >1 to <16 years of age: SLV (mL) = −20.2472281 + 3.339056437 × height (cm) + 13.11312561 × weight (kg) >16 years of age: SLV (mL) = 1072.8 × ([weight (kg)] 0.425 × [height (cm)] 0.725 × 0.007184) − 345.7 …”