Accuracy of preoperative CT liver volumetry in living donor hepatectomy and its clinical implications

Goja, Sanjay; Yadav, Sanjay Kumar; Yadav, Amardeep; Piplani, Tarun; Rastogi, Amit; Bhangui, Prashant; Saigal, Sanjiv; Soin, Arvinder S.

doi:10.21037/hbsn.2017.08.02

Cited by 22 publications

(25 citation statements)

References 24 publications

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“…In this study, we obtained a statistically signicant strong correlation between EGW and AGW for RL grafts with MHV (Spearman's correlation r =0.786 and p < 0.001), RL grafts without MHV (Spearman's correlation r =0.968 and p < 0.001) and LL grafts (Spearman's correlation r =0.809 and p < 0.001). This is consistent with a study conducted by Sanjay Goja et al in 842 donors, in which they found a statistically signicant strong correlation between EGW and AGW for RL grafts (r=0.82, P<0.001) and LL grafts (r=0.81, P<0.001) and statistically signicant moderate correlation between EGW and AGW for LLS grafts (r=0.49, P<0.001) (7). A study by T. Yoneyama et al also showed that the correlation coefcient between EGW and AGW was 0.84 in right lobe grafts and 0.85 in left lobe grafts (p<0.001), indicating a statistically signicant correlation which is consistent with our results (8).…”

supporting

confidence: 92%

Comparison of Semi-Automated Ct Volumetry and Intraoperative Graft Weight in Potential Donors for Living Donor Liver Transplantation (Ldlt)

Moorthy

Shibu

Devarmani

2021

IJAR

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Aim: The aim is to study the correlation between estimated graft weight (EGW) and actual graft weight (AGW) in potential donors for LDLT. Materials and Methods: The study cohort consisted of 133 right lobe (RL) with middle hepatic vein (MHV), 23 RL without MHV and 17 left lobe (LL) grafts assessed between August 2018 and August 2020. EGW was calculated using semi-automated volumetry technique in Philips IntelliSpace portal workstation and AGW was measured intra-operatively by the transplant team after graft retrieval from the donor. To find the agreement between AGW and EGW, intra-class correlation co-efficient (ICC) was computed. To find the degree of correlation between EGW and AGW, Spearman’s rho correlation co-efficient was computed. Bland Altman plot was used for assessing the level of agreement between two methods. Results: The mean age of donors was 38.9 +/- 9.9 years (Female:Male::121:52). The correlation between EGW and AGW for all three types of grafts was significant (p<0.001). RL with MHV: Spearman’s rho r=0.786, ICC=0.883; RL without MHV: Spearman’s rho r= 0.968, ICC=0.986 and LL: Spearman’s rho r= 0.809, ICC=0.937. Bland Altman’s analysis showed that CT volumetry overestimated 5 and underestimated 1 RL grafts with MHV, overestimated 1 RL grafts without MHV and underestimated 1 LL grafts. Conclusion: CT volumetry has a definitive role in the pre-operative evaluation of prospective liver donors. EGW calculated by semi-automated CT volumetry in potential LDLT donors is accurate and correlates well with AGW measured intra-operatively for both right and left lobe grafts.

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confidence: 92%

Comparison of Semi-Automated Ct Volumetry and Intraoperative Graft Weight in Potential Donors for Living Donor Liver Transplantation (Ldlt)

Moorthy

Shibu

Devarmani

2021

IJAR

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“…For the Left lateral segment (LLS) graft, CT may underestimate the volume because the actual surgical plane of transection is around 1 cm to the right of a falciform ligament whereas radiological plane is at falciform ligament. In addition to that non-hepatic tissues like falciform ligament which are excluded in CT volumetry are a part of LLS allograft included in AGW [14].…”

Section: Discussionmentioning

confidence: 99%

Dual graft living donor liver transplantation – a case report

et al. 2019

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BackgroundLiving donor liver transplantation (LDLT) has emerged as an equally viable option to deceased donor liver transplant for treating end stage liver disease patients. Optimising the recipient outcome without compromising donor safety is the primary goal of LDLT. Achieving the adequate graft to recipient weight ratio (GRWR) is important to prevent small for size syndrome which is an uncommon but potentially lethal complication of LDLT.Case presentationHere we describe a case of successful dual lobe liver transplant for a 32 years old patient with ethanol related end stage liver disease. A right lobe graft without middle hepatic vein and another left lateral sector graft were transplanted successfully. Recipient and both donors recovered uneventfully.ConclusionDual lobe liver transplant is a feasible strategy to achieve adequate GRWR without compromising donor safety.

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“…A GRWR of 0.8% was desirable, but a GRWR as low as 0.60% was accepted in patients with MELD scores of 18 or less and Karnofsky Performance Status (KPS) scores of >60. The minimum acceptable future liver remnant was 30% of the total liver volume estimated on computed tomography scan prior to transplant . The actual graft weight was measured on the bench after flushing the graft with University of Wisconsin solution at 4°C.…”

Section: Methodsmentioning

confidence: 99%

“…The minimum acceptable future liver remnant was 30% of the total liver volume estimated on computed tomography scan prior to transplant. (21) The actual graft weight was measured on the bench after flushing the graft with University of Wisconsin solution at 4°C. The actual GRWR was considered while deciding the method of PIM.…”

Section: Standard Ldlt Protocolmentioning

confidence: 99%

Is Portal Inflow Modulation Always Necessary for Successful Utilization of Small Volume Living Donor Liver Grafts?

et al. 2019

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Although the well‐accepted lower limit of the graft‐to‐recipient weight ratio (GRWR) for successful living donor liver transplantation (LDLT) remains 0.80%, many believe grafts with lower GRWR may suffice with portal inflow modulation (PIM), resulting in equally good recipient outcomes. This study was done to evaluate the outcomes of LDLT with small‐for‐size grafts (GRWR <0.80%). Of 1321 consecutive adult LDLTs from January 2012 to December 2017, 287 (21.7%) had GRWR <0.80%. PIM was performed (hemiportocaval shunt [HPCS], n = 109; splenic artery ligation [SAL], n = 14) in 42.9% patients. No PIM was done if portal pressure (PP) in the dissection phase was <16 mm Hg. Mean age of the cohort was 49.3 ± 9.1 years. Median Model for End‐Stage Liver Disease score was 14, and the lowest GRWR was 0.54%. A total of 72 recipients had a GRWR <0.70%, of whom 58 underwent HPCS (1 of whom underwent HPCS + SAL) and 14 underwent no PIM, whereas 215 had GRWR between 0.70% and 0.79%, of whom 51 and 14 underwent HPCS and SAL, respectively. During the same period, 1034 had GRWR ≥0.80% and did not undergo PIM. Small‐for‐size syndrome developed in 2.8% patients. Three patients needed shunt closure at 1 and 4 weeks and 60 months. The 1‐year patient survival rates were comparable. In conclusion, with PIM protocol that optimizes postperfusion PP, low‐GRWR grafts can be used for appropriately selected LDLT recipients with acceptable outcomes.

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Accuracy of preoperative CT liver volumetry in living donor hepatectomy and its clinical implications

Abstract: CT volumetry overestimate LL graft and underestimate LLS graft weight. This should be factored in when selecting LL graft by taking higher GRWR.

Cited by 22 publications

References 24 publications

Comparison of Semi-Automated Ct Volumetry and Intraoperative Graft Weight in Potential Donors for Living Donor Liver Transplantation (Ldlt)

Comparison of Semi-Automated Ct Volumetry and Intraoperative Graft Weight in Potential Donors for Living Donor Liver Transplantation (Ldlt)

Dual graft living donor liver transplantation – a case report

Is Portal Inflow Modulation Always Necessary for Successful Utilization of Small Volume Living Donor Liver Grafts?

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