Ratio of remnant to total liver volume or remnant to body weight: which one is more predictive on donor outcomes?

Yaprak, Onur; Guler, Necdet; Altaca, G; Dayangaç, Murat; Demirbas, Tolga; Akyıldız, Murat; Ulusoy, Levent; Tokat, Yaman; Yüzer, Yıldıray

doi:10.1111/j.1477-2574.2012.00483.x

Cited by 19 publications

(40 citation statements)

References 31 publications

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“…Although a RV/TLV of at least 30%-35% is usually required to avoid small-for-size syndrome (SFSS) [1,4,8] , successful outcomes with RV/TLV < 30% have been reported in the setting of optimal liver quality [6,7,11,24] . Inclusion of the MHV with right grafts, which has been reported to optimize graft function [1,4,7,25] but to potentially impair remnant recovery [1,[26][27][28] , has both …”

Section: Discussionmentioning

confidence: 99%

“…Yaprak et al [11] had observed that RV/TLV ≤ 30% impacted donor outcome (especially postoperative hyperbilirubinemia and major complications) irrespective of donor RVBWR (< 0.6 or > 0.6). In their experience, RVBWR < 0.6 significantly affected liver function but not donor morbidity.…”

Section: Table 4 Middle Hepatic Vein Management In Small-for-size -Rementioning

confidence: 99%

“…In a prospective study by Dayangac et al [7] , procurement of right grafts inclusive of MHV was not associated with any additional donor risk except in SFS-remnants with RV/TLV < 30% (57% complication rate and prolonged postoperative hyperbilirubinemia). Others showed an association between small remnant volume and donor morbidity [1,11,36,37] . In our series the slightly higher bilirubin and INR levels in SFS-remnants probably resulted from a small RV.…”

Section: Table 4 Middle Hepatic Vein Management In Small-for-size -Rementioning

confidence: 99%

“…The occurrence of small-for-size syndrome (SFSS) in donors as a result of inadequate functional remnant volume is a constant reminder of the controversy surrounding venous congestion and MHV management. The commonly accepted definitions for small-for-size-(SFS)-remnants do not even consider remnant volume values [4,[6][7][8][9][10][11] . To date, there are no published reports correlating the extent of functional impairment and parenchymal congestion in non-MHV containing remnants, and remnant volume limits for safe MHV inclusion with the right graft are still undefined.…”

Section: Introductionmentioning

confidence: 99%

“…We finally considered "reasonable" criteria for procurement of right grafts with/without complete MHV vs selective MHV-4A preservation in remnants based both on our own experience with donors without evidence of steatosis as well as on that of others [4,[6][7][8][11][12][13][14][15][16] .…”

Section: Introductionmentioning

confidence: 99%

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Risk of venous congestion in live donors of extended right liver graft

Radtke¹,

Sgourakis²,

Molmenti³

et al. 2015

WJG

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AIM:To investigate middle hepatic vein (MHV) management in adult living donor liver transplantation and safer remnant volumes (RV). METHODS:There were 59 grafts with and 12 grafts without MHV (including 4 with MHV-5/8 reconstructions). All donors underwent our five-step protocol evaluation containing a preoperative protocol liver biopsy Congestive vs non-congestive RV, remnantvolume-body-weight ratios (RVBWR) and postoperative outcomes were evaluated in 71 right graft living donors. Dominant vs non-dominant MHV anatomy in total liver volume (d-MHV/TLV vs nd-MHV/TLV) was constellated with large/small congestion volumes (CVindex). Small for size (SFS) and non-SFS remnant considerations were based on standard cut-off-RVBWR and RV/TLV. Non-congestive RVBWR was based on non-congestive RV. RESULTS:MHV and non-MHV remnants showed no significant differences in RV, RV/TLV, RVBWR, total bilirubin, or INR. SFS-remnants with RV/TLV < 30% and non-SFS-remnants with RV/TLV ≥ 30% showed Prospective Study Risk of venous congestion in live donors of extended right liver graftArnold Radtke, George Sgourakis, Ernesto P Molmenti, Susanne Beckebaum, Vito R Cicinnati, Hartmut Schmidt,Christoph E Broelsch, Massimo Malagó, Tobias Schroeder Radtke A et al . Liver failure in live donors of right grafts 6009May 21, 2015|Volume 21|Issue 19| WJG|www.wjgnet.com no significant differences either. RV and RVBWR for non-MHV (n = 59) and MHV-containing (n = 12) remnants were 550 ± 95 mL and 0.79 ± 0.1 mL vs 568 ± 97 mL and 0.79 ± 0.13, respectively (P = 0.423 and P = 0.919. Mean left RV/TLV was 35.8% ± 3.9%.Non-MHV (n = 59) and MHV-containing (n = 12) remnants (34.1% ± 3% vs 36% ± 4% respectively, P = 0.148. Eight SFS-remnants with RVBWR < 0.65 had a significantly smaller RV/TLV than 63 non-SFSremnants with RVBWR ≥ 0.65 [SFS: RV/TLV 32.4%(range: 28%-35.7%) vs non-SFS: RV/TLV 36.2% (range: 26.1%-45.5%), P < 0.009. Six SFS-remnants with RV/TLV < 30% had significantly smaller RVBWR than 65 non-SFS-remnants with RV/TLV ≥ 30% (0.65 (range: 0.6-0.7) vs 0.8 (range: 0.6-1.27), P < 0.01. Two (2.8%) donors developed reversible liver failure. RVBWR and RV/TLV were concordant in 25%-33% of SFS and in 92%-94% of non-SFS remnants. MHV management options including complete MHV vs MHV-4A selective retention were necessary in n = 12 vs n = 2 remnants based on particularly risky congestive and non-congestive volume constellations. CONCLUSION:MHV procurement should consider individual remnant congestive-and non-congestive volume components and anatomy characteristics, RVBWR-RV/TLV constellation enables the identification of marginally small remnants.

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Section: Discussionmentioning

confidence: 99%

Section: Table 4 Middle Hepatic Vein Management In Small-for-size -Rementioning

confidence: 99%

Section: Table 4 Middle Hepatic Vein Management In Small-for-size -Rementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Risk of venous congestion in live donors of extended right liver graft

Radtke¹,

Sgourakis²,

Molmenti³

et al. 2015

WJG

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Risk factors of posthepatectomy liver failure for perihilar cholangiocarcinoma

Lee

Park

et al. 2020

Journal of Surgical Oncology

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Background Surgery for perihilar cholangiocarcinoma (PHCC) is associated with high morbidity. This study aimed to investigate the clinical value of the future liver remnant volume‐to‐body weight (FLRV/BW) and propose a risk score for predicting the risk of patients with PHCC developing posthepatectomy liver failure (PHLF). Methods This study included 348 patients who underwent major hepatectomy with bile duct resection for PHCC during 2008‐2015 at a single center in Korea and they were retrospectively analyzed. Results Clinically relevant PHLF was noted in 40 patients (11.4%). The area under the curve (AUC) for FLRV/BW was not significantly different from that for FLRV/total liver volume (P = .803) or indocyanine green clearance of the future liver remnant (P = .629) in terms of predicting PHLF. On multivariate analysis, predictors of PHLF (P < .05) were male sex, albumin less than 3.5 g/dL, preoperative cholangitis, portal vein resection, FLRV/BW less than 0.5%, and FLRV/BW 0.5% to 0.75%. These variables were included in the risk score that showed good discrimination (AUC, 0.853; 95% CI, 0.802‐0.904). It will help rank patients into three risk subgroups with a predicted liver failure incidence of 4.75%, 18.73%, and 51.58%, respectively. Conclusions FLRV/BW is a comparable risk prediction factor of PHLF and the proposed risk score can help to predict the risk of planned surgery in PHCC.

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