Hypoattenuation in unenhanced CT reflects histological graft dysfunction and predicts 1-year mortality after living donor liver transplantation

Abstract

Early postoperative graft function assessments are essential after living donor liver transplantation (LDLT) to predict patient and graft outcome. Computed tomography (CT) is usually used to evaluate various complications and parenchymal abnormalities after LDLT. Here, we attempted to determine the prognostic values of CT attenuation changes of grafts for predicting 1-year patient survival. Liver attenuation indices (LAIs), derived from differences between hepatic and splenic attenuations, were calculated on unenhanced CT images obtained 10 days after LDLT in 62 adult LDLT recipients between September 2002 and August 2004. Patients were assigned to 1 of 2 groups according to LAI value on the 10th postoperative day, as follows: group L (LAI Յ 5, n ϭ 14) or group H (LAI Ͼ 5, n ϭ 48). Parenchymal dysfunction scores, summed parameters for histological dysfunction including both portal tract and centrilobular features, were also assessed on the 10th postoperative day using liver biopsy specimens. Histological parenchymal dysfunction, especially in the centrilobular area, in terms of cholestasis, centrilobular necroinflammation, central vein fibrosis, steatosis, mononuclear infiltrates, and hepatocyte ballooning, was more prominent in group L than in group H, while that in the portal area was similar between the 2 study groups. Significant negative linear correlations were observed between LAI and parenchymal dysfunction scores (r ϭ 0.486, P Ͻ 0.001). Group L patients showed lower 1-year survival (69.7%) than group H patients (95.8%; P ϭ 0.0002). Moreover, group H patients died with a functioning graft (n ϭ 3), whereas group L patients died of graft failure (n ϭ 6). After multivariate analysis, LAI alone remained independently associated with 1-year mortality (P ϭ 0.014; odds ratio ϭ 0.845; 95% confidence interval, 0.739-0.967). The sensitivity and specificity of LAI were 84.6% and 75%, respectively, and LAI outperformed MELD score as a predictor of 1-year mortality after LDLT by receiver operating characteristic curve analysis. In conclusion, LAI, as determined by unenhanced CT 10 days after LDLT, well predicts 1-year patient survival after LDLT. Liver Transpl 12:1403-1411 AASLD. Received February 2, 2006 accepted February 15, 2006. See Editorial on Page 1320A critical shortage of cadaveric organs has resulted in a high mortality rate among patients awaiting liver transplantation (LT). It is hoped that an increasing number of living donor liver transplant (LDLT) procedures will significantly reduce the number of deaths among those on waiting lists. During the last 10 years, adult-to-adult LDLT has been developed on an international scale. A graft size of about 50% of the standard liver volume or 1.0% of the graft-to-recipient weight ratio (GRWR) is necessary to secure a favorable outcome after LDLT. Therefore, the widespread application of LDLT is limited

Donor Safety in Living Donor Liver Transplantation: A Single-Center Analysis of 300 Cases

“…When the graft was completely separated, we quickly removed the graft to a table and flushed it with University of Wisconsin solution through the pulmonary veins (PV) and hepatic artery at 4°C. The volume of the grafts was measured with a 3-L beaker using a drainage method intraoperatively, and the error was within 10 mL [23], [24]. Donors stayed in the intensive care unit (ICU) for the day of the operation and were transferred to the surgical ward when their conditions stabilized.…”

Improved outcome of adult recipients with a high model for end-stage liver disease score and a small-for-size graft

“…Donors were selected according to a protocol described elsewhere 20–23. The selected donors were 120 men and 47 women; 69 patients were gender‐mismatched.…”

Evaluation of standard liver volume formulae for Chinese adults

“…All preoperative CT examinations of donors were performed by a single radiologist and all donor procedures were performed by the same surgical unit. The volume of the grafts was measured by a 3 L beaker using a drainage method intraoperatively and the error was less than 10 mL [17,18] . Right liver g raft without middle hepatic vein reconstruction from a living donor was performed as described, with temporary occlusion of the right portal vein (PV) and right hepatic artery and use of ultrasonography to guide parenchymal transection.…”