Reliability of CT volumetry as a tool to calculate the preoperative donor liver volume: Correlation with the intraoperative graft weight in living donor liver transplantation (LDLT)

Abstract

Liver transplantation has become an ideal management for end stage liver diseases. The preoperative volumetric assessment of donor liver is an important factor in determining the surgical strategy and in predicting post operative donor and recipient mortality and morbidity. CT has high spatial and contrast resolution and provides comprehensive parenchymal vascular and volumetric preoperative evaluation of donor undergoing live donor liver transplant and its accuracy can be established by comparing it with the intraoperative actual graft volume. Materials and Methods : 52 patients who underwent donor right hepatectomy were included in the study and underwent CT scanning during the period from July 2017 to June 2019. Manual tracing of CT volumetry was done for calculating liver volume. The actual liver volume is obtained by weighing the graft immediately after resection. The difference between preoperative CT volume and intraoperative graft weight was defined as a percentage error ratio, which was classified as overestimation (+) and underestimation (-). Results: In 28 (53.8%) cases, right lobe liver grafts obtained including MHV, whereas in 24(46.2%) cases right liver lobe grafts obtained excluding MHV. The mean preoperative liver volume calculated was 816.5+ 142.5g, while the mean volume measured intraoperatively was 812.6 g + 136.8g. The mean volume difference between preoperative and actual graft volume was 51.96+33.65cm 3 (range 4-131cm 3). The mean error ratio was 6.59+4.623%. 30(57.7%) cases had underestimation, whereas 22(42.3%) cases had overestimation of liver volume. The mean preoperative volume had a good correlation with actual graft volume. Conclusion: The present study concludes that CT volumetry accurately predicted preoperative graft volume and showed excellent correlation with actual graft volume.

Correlating CT Volumetry with Actual Graft Volume in Living Donor Liver Transplantation: A Retrospective Analysis

“…On the other hand, grafts that diverge signi cantly from the optimal size, either being excessively diminutive or large, can precipitate a myriad of complications for the recipient [6]. A small graft may not ful ll the metabolic requirements of the recipient resulting in deranged liver functions, hyperbilirubinemia, ascites, portal hypertension and prolonged prothrombin time (PT), Conversely, a large graft may result in risk of reduced perfusion due to vascular compromise, graft compression, di culty in abdominal closure and unfavorable vascular orientation [7]. Residual liver of 30-40% of original total liver volume is required for the donor to survive provided it is functionally normal.…”