Stereological evaluation of liver volume in living donor liver transplantation using MDCT via the cavalieri method

Abstract

In living donor liver transplantation (LDLT), obtaining the precise volume of the graft is very important to decrease volumerelated postoperative complications, especially in cases with suspected small-for size grafts. We used stereology based on the Cavalieri method (CM), a new method to measure liver graft volume, and compared the results with those obtained through intraoperative measurement (IOM) and through multidetector computed tomography (MDCT) measurement. Liver volumes estimated using the 3 methods were well-correlated with each other (r 2 ϭ 0.94 and P Ͻ 0.001 for IOM and CM; r 2 ϭ 0.91 and P Ͻ 0.001 for IOM and MDCT, and r 2 ϭ 0.95 and P Ͻ 0.001 for CM and MDCT); however, they were different from each other (in descending order, 908 Ϯ 124 cm 3 , 861 Ϯ 121 cm 3 , and 777 Ϯ 168 cm 3 for MDCT, CM, and IOM, respectively). Although MDCT and CM overestimated the volumes, the results of CM were almost similar to those obtained via IOM. In conclusion, our results suggest that CM measured the liver graft volume more reliably. Thus, its use, particularly in cases with suspected small-for-size graft, may prove useful. Liver Transpl 13: [693][694][695][696][697][698] 2007 The shortage of cadaveric livers for transplantation continues to limit this therapy, but the use of living donors and split grafts has helped to solve this problem.1 In living donor liver transplantation (LDLT), an exact preoperative volume calculation of both the graft to be transplanted and the remaining part of the potential donor liver is crucial to avoid severe postoperative complications associated with the graft volume and the recipient recovery rate, and to maintain donor safety. 1-3The use of small-for-size grafts (graft-to-recipient weight ratio Ͻ1%) has been found to lead to lower graft survival. This lower survival rate is caused by enhanced parenchymal cell injury and reduced metabolic and synthetic capacity. Currently, LDLT is planned by multiple imaging approaches using planar reformations of ultrasonography, computed tomography (CT), magnetic resonance, and angiographic examinations. 4,5 Recently, preoperative liver volumetry-based on contrast-enhanced multidetector CT (MDCT) has resulted in significantly improved outcomes, compared to the use of 2-dimensional CT.6-11 The MDCT images revealed the anatomy of the hepatic vein, hepatic artery, and portal vein, but unfortunately volumetry by MDCT still produces an error ratio of approximately 13%.2 The error might be due to factors such as the mismatch between the cutting line in the simulation and that in the actual hepatectomy and possible changes in graft volume secondary to the lack of blood pressure on the vascular bed of the graft. On the other hand, the Cavalieri principle (CM) of stereological methodology is well suited to rapid and Abbreviations: LDLT, living donor liver transplantation; CM, Cavalieri method; IOM, intraoperative measurement; MDCT, multidetector computed tomography; CT, computed tomography; MHV, middle hepatic vein. Address reprint requests to Bulent Aydinli...

Preoperative estimation of the liver graft weight in adult right lobe living donor liver transplantation using maximal portal vein diameters

“…The minimum graft size required for LDLT to provide adequate functional hepatic mass has been reported to be 30% to 40% of the recipient's weight5, 19, 20 (or GRWR = 0.8%‐1.0%21, 22). On the other hand, the donor liver remnant must be greater than 30% of the original liver to ensure donor safety and prevent postoperative hepatic insufficiency 7, 23. The advances in noninvasive, radiological volumetric techniques (CT and MRI) have simplified the process of donor evaluation 4.…”

Stereology: a novel technique for rapid assessment of liver volume

“…This method, however, is the basis of an already published study [12] and is a reliable and acceptable method [16]. In fact one study has found stereology better than volumetry when compared to intra-operative liver volume measurements [17]. In another study, Doherty and colleagues were able to show that stereology was superior to semi-automated volumetry for measurement of the temporal lobe [18].…”

Evaluation of standard liver volume formulae for Chinese adults

“…Inclusion criteria were: (1) a healthy adult donor, aged 19-59 years; (2) right liver graft without middle hepatic vein; (3) adultto-adult LDLT; (4) single donor; (5) no history of long term drinking. Exclusion criteria: (1) donor age < 18 or > 60 years; (2) left hepatic graft or left lateral lobe graft; (3) double donor grafts; (4) adult-to-child transplant; (5) donors who were hepatitis B or C carriers [11][12][13][14] .…”