Reliable Estimation of Preoperative Graft Volume in Living Donor Liver Transplantation

Aims & Objectives: Corner stone in performing living donor liver transplant is to assess and predict the adequacy of the donated liver for recipient and remaining liver. Previously the conversion of liver volume to estimated weight is done by using unit to unit conversion with a factor of 1. We analyzed data of our institute to research the methodology and local applicability of the same. Place and duration of study: Shaikh Zayed Hospital, Lahore. January 2011 to June 2017 Material & Methods: Retrospective data was collected for the first 115 recipients and donors. Their preoperative liver volumes calculated by C.T scan and post-operative graft harvested with weights were compared. Results: The parameter of actual volume of right lobe averaged to 769.77 ± 12.73 gm varying with a quantum of 17.73% (426 – 1123 gm). Estimated volume of right lobe of liver varied 358 to 1218 ml (CV = 17.84%) with an average value of 798.96 ± 13.29 ml. Results of linear regression between estimated volume of right lobe and actual weight of the right lobe in gm was significantly linear (r = 0.830, r2 = 0.690, adj. r2 = 0.689 and F = 250.98, p < 0.0001), showing that volumetric assessment overestimated graft weight/volume. Following is equation generated from our data for graft weight estimation. Actual right lobe (g) = 134.004 + 0.796 (estimated right lobe volume (ml) ± 76.42. Conclusion: Using one to one principle for volume estimation of healthy liver can be misleading and therefore we propose an equation to reach more accurate estimation of graft weight. Keywords: living donor liver transplant, CT volumetry, graft to body weight ratio

Impact of Graft Weight Change During Perfusion on Hepatocellular Carcinoma Recurrence After Living Donor Liver Transplantation

BackgroundsInadequate liver volume and weight is a major source of morbidity and mortality after adult living donor liver transplantation (LDLT). The purpose of our study was to investigate HCC recurrence, graft failure, and patient survival according to change in right liver graft weight after histidine-tryptophan-ketoglutarate (HTK) solution perfusion in LDLT.MethodsTwo hundred twenty-eight patients underwent LDLT between 2013 and 2017. We calculated the change in graft weight by subtracting pre-perfusion graft weight from post-perfusion graft weight. Patients with increased graft weight were defined as the positive group, and patients with decreased graft weight were defined as the negative group.ResultsAfter excluding patients who did not meet study criteria, 148 patients underwent right or extended right hepatectomy. The negative group included 89 patients (60.1%), and the positive group included 59 patients (39.9%). Median graft weight change was -28 g (range; -132–0 g) in the negative group and 21 g (range; 1–63 g) in the positive group (P&lt;0.001). Median hospitalization time was longer for the positive group than the negative group (27 days vs. 23 days; P=0.048). There were no statistical differences in tumor characteristics, postoperative complications, early allograft dysfunction, or acute rejection between the two groups. Disease-free survival, death-censored graft survival, and patient survival were lower in the positive group than the negative group. Additionally, the positive group showed strong association with HCC recurrence, death-censored graft survival, and patient survival in multivariate analysis.ConclusionThis study suggests that positive graft weight change during HTK solution perfusion indicates poor prognosis in LDLT.

Pediatric Thoracoscopic Repair of Diaphragmatic Herniation Following Liver Transplantation

Diaphragmatic Hernia (DH) after Liver Transplantation (LT) is a rare complication with unclear pathophysiology. Among 261 LT, we recognized six DH during the post transplant period (2.30%). All patients with DH had received a left lateral segment (LLS) reduced graft. The mean graft weight was 340g with a mean graft-to-recipient body weight ratio (GBWR) of 4.20%. LLS grafts, a GBWR > 4%, previous abdominal surgery and direct trauma during surgery can be enumerated as potential risk factors for DH post-LT. These children underwent prompt surgical intervention to DH without complications. Three patients were treated via laparotomy and three by thoracoscopy. No clinical recurrences were accounted at a mean follow up of 5 years. Historically, the treatment has always been surgical repair via laparotomy but the use of minimally invasive techniques in pediatric surgery has been increasing, and the thoracoscopic approach for DH can bring advantages. The patients in which the thoracoscopic approach was used had shorter operative times and a faster recovery with better cosmetic results. As previous surgical manipulation had been done to the abdominal cavity, thoracoscopy seems to be a safe approach in DH in pediatric LT recipients.

COMPARISON OF SEMI-AUTOMATED CT VOLUMETRY AND INTRAOPERATIVE GRAFT WEIGHT IN POTENTIAL DONORS FOR LIVING DONOR LIVER TRANSPLANTATION (LDLT)

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.