Estimation of Standard Liver Volume for Liver Transplantation in the Chinese Population

doi:10.1016/j.transproceed.2008.07.135

Transplantation Proceedings

Volume 40, Issue 10, December 2008, Pages 3536-3540

https://doi.org/10.1016/j.transproceed.2008.07.135 Get rights and content

Abstract

Introduction

The accurate assessment of standard liver volume (SLV) is necessary for the safety of both the donor and the recipient in living donor liver transplantation. However, the accuracy of SLV formulas relates to cohorts or races. This study examined the accuracy of a simple linear formula versus previous formulas of SLV for Chinese adults.

Methods

Among 112 patients with normal liver, we created a new formula for SLV with stepwise regression analysis using the following variables: age, gender, body weight, body height, body mass index, and body surface area. The agreement between the actual liver volume (LV) and calculated LV using various formulas was prospectively evaluated among 63 living donors by paired-sample student's t-test and Lin's concordance correlation coefficient.

Results

A new formula was developed SLV (mL) = 949.7 × BSA (m²) − 48.3 × age − 247.4 where age was counted as 1 for those <40, 2 if 41–60, and 3 if >60 years old. The calculated LV using our formula showed no significant difference from the actual LV using the paired-samples student's t-test (P = .653). Lin's concordance correlation coefficient showed substantial agreement between estimated LV using our formula and actual LV. Furthermore, this study also observed an almost perfect agreement between our formula and the Yoshizumi et al formula.

Conclusion

Our formula, which accurately estimated LV among Chinese adults, may be applicable to adults of other ethnicitis.

Section snippets

Patients

We retrospectively investigated the data from 112 consecutive patients including 66 males and 46 females of overall mean age of 48.7 ± 12.4 years (range, 19–73), who underwent upper abdominal helical computed tomography (CT) scans between January 2006 and September 2006. All patients had no hepatobiliary, hepatitis B or C surface antigen evidence of disease, we excluded. Patients with conditions potentially affected by the biliary tree, such as pancreatic disease, an associated with the

Subject Characteristics

The characteristics of all 112 patients with normal livers and 63 actual living donors are summarized in (Table 1). There was only significant difference between these 2 groups was age (P = .000). The condition of liver biochemistry tests showed no significant difference between the cases (n = 175) and the healthy population (P = .763).

Establishing a New Formula for SLV in Subjects With Normal Liver

The total liver volume was 1220.1 ± 216.1 mL (range, 804.45–1780.53) among subjects with normal livers. Five selected anthropometric variables, including age,

Discussion

The aim of our study was to create an accurate formula to estimate liver volume in Chinese adults. The results of this study demonstrated that among healthy Chinese adults, liver volume was positively related to BSA and negatively correlated with age. Previous studies8, 10, 17 had also indicated a negative relation between age and LV. In addition, there was no significant correlation between gender and LV. Thus, our formula can be applicable to both genders.

Many formulae for SLV have been

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Cited by (49)

Shulan Estimation Model: A New Formula for Estimation of Standard Liver Volume In Chinese Adults
2022, Transplantation Proceedings
Citation Excerpt :
For the proportions of estimated SLV with percentage errors within acceptable agreement, Lin's, Yu's, Johnson's, and our model had a similar accuracy (about 70% within ±20% agreement, 55% within ±15% agreement, 40% within ±10% agreement). Since Dealand et al first proposed a model for estimating SLV based on BSA [27], many international studies have regarded BSA as an independent related factor for LV estimation [14,15,17,20,24,36]. The BSA was regarded as the most widely accepted parameter for determining SLV.
To establish a new and accurate model for standard liver volume (SLV) estimation and graft size prediction in liver transplantation for Chinese adults.
In this study, the data of morphologic indices and liver volume (LV) were retrospectively obtained on 507 cadaveric liver transplantation donors between June 2017 and September 2020 in Shulan (Hangzhou) Hospital. Linear regression analysis was performed to evaluate the impact of each parameter and develop a new SLV formula. The new formula was then validated prospectively on 97 donors between October 2020 and June 2021, and the prediction accuracy was compared with previous formulas.
The average LV in all subjects was 1445.68 ± 309.94 mL. Body weight (BW) showing the strongest correlation (r = 0.453, P < .001). By stepwise multiple linear regression analysis, BW and age were the only 2 independent correlation factors for LV. Shulan estimation model derived: SLV (mL) = 13.266 × BW (kg) – 4.693 × age + 797.16 (R2 = 0.236, P < .001). In the validation cohort, our new model achieved no significant differences between the estimated SLV and the actual LV (P > .05), and showed the lowest mean percentage error of 0.33%. The proportions of estimated SLV within the actual LV ± 20%, ± 15%, and ± 10% percentage errors were 69.1%, 55.7%, and 40.2%, respectively.
The Shulan SLV estimation model predicted LV more accurately than previous formulas on Chinese adults, which could serve as a simple screening tool during the initial assessment of graft volume for potential donors.
Left lateral segment liver volume is not correlated with anthropometric measures
2021, HPB
Liver transplantation is definitive therapy for end stage liver disease in pediatric patients. Living donor liver transplantation (LDLT) with the left lateral segment (LLS) is often a feasible option. However, the size of LLS is an important factor in donor suitability – particularly when the recipient weighs less than 10 kg. In the present study, we sought to define a formula for estimating left lateral segment volume (LLSV) in potential LLS donors.
We obtained demographic and anthropometric measurements on 50 patients with Computed Tomography (CT) scans to determine whole liver volume (WLV), right liver volume (RLV), and LLSV. We performed univariable and multivariable linear regression with backwards stepwise variable selection (p < 0.10) to determine final models.
Our study found that previously reported anthropometric and demographics variables correlated with volume were significantly associated with WLV and RLV. On univariable analysis, no demographic or anthropometric measures were correlated with LLSV. On multivariable analysis, LLSV was poorly predicted by the final model (R2 = 0.10, Coefficient of Variation [CV] = 42.2) relative to WLV (R2 = 0.33, CV = 18.8) and RLV (R2 = 0.41, CV = 15.8).
Potential LLS living donors should not be excluded based on anthropometric data: all potential donors should be evaluated regardless of their size.
Comparison Between Pre-operative Radiologic Findings and the Actual Operative Findings of the Graft in Adult Living Donor Liver Transplantation
2020, Transplantation Proceedings
Citation Excerpt :
Those studies use several conflicting formulas to predict the graft sizes. These different formulas depend on many different variables in addition to EGV, such as body weight, body surface area (BSA), portal vein, donor age, donor sex, and whole liver volumes [7,23–29]. In our study, we considered the weight of the right lobe graft after resection and after being washed by the HTK solution as the actual graft weight to prevent confounding bias.
Computed tomography (CT) volumetry and magnetic resonance cholangiopancreatography (MRCP) are mandatory steps for the evaluation of potential donors in living donor liver transplantation. The aim of this study is to compare the preoperative CT volumetry and biliary orifices of the donor graft to the actual operative findings.
Between December 2013 and December 2017, 45 donors (27 men and 18 women) with a mean age of 27.3 years (range, 19-41 years) were evaluated preoperatively by CT volumetry and MRCP at the National Hepatology and Tropical Medicine Research Institute in Cairo, Egypt. Of the donors, 43 out of 45 underwent intraoperative cholangiography before and after bile duct division. The right hepatectomies for all donors, as well as the actual weight and apparent biliary orifices in the graft, were documented.
The mean estimated graft volume (EGV) preoperatively by CT volumetry was 894.9 ± 184.2 mL (range, 480-1687 mL), whereas the actual graft weight (AGW) intraoperatively after washout was 862.6 ± 124.4 g (range, 676-1110 g). The correlation coefficient between the EGV and AGW was significantly linear (Y = 0.96X, r² = 0.72, slope: 0.96, P < .001). The accuracy of the MRCP in preoperative biliary mapping was 76.7% whereas the accuracy of the MRCP in predicting the number of graft biliary orifices was 74.4% compared with the intraoperative cholangiography (IOC), which was 95.3% (P < .001).
The weight of the right lobe of the liver graft in living donor liver transplants (LDLTs) can be accurately predicted preoperatively by multiplying the EGV by 0.96. Also, the IOC is an essential technique for LDLT.
Accuracy of estimated total liver volume formulas before liver resection
2019, Surgery (United States)
Future remnant liver volume is used to predict the risk for liver failure in patients who will undergo major liver resection. Formulas to estimate total liver volume based on biometric data are widely used to calculate future remnant liver volume; however, it remains unclear which formula is most accurate. This study evaluated published estimate total liver volume formulas to determine which formula best predicts the actual future remnant liver volume based on measurements in a large number of patients who underwent associating liver partition and portal vein ligation for staged hepatectomy surgery.
All patients with complete liver volume data in the associating liver partition and portal vein ligation for staged hepatectomy registry were included in this study. Estimate total liver volume and estimated future remnant liver volume were calculated for 16 published formulas. The median over- or underestimation compared with actual measured volumes were determined for estimate total liver volume and future remnant liver volume. The proportion of patients with an under- or overestimated future remnant liver volume for each formula were compared with each other using a 25% cut-off for each formula.
Among 529 studied patients, the formulas ranged from a 19% underestimation to a 63% overestimation of estimate total liver volume. Estimation of future remnant liver volume lead to a 10% underestimation to a 5% overestimation among the formulas. Of all studied formulas, the Vauthey1 formula was the most accurate, generating underestimation of future remnant liver volume in 20% and overestimation of future remnant liver volume in 6% of patients.
Validation of 16 published total liver volume formulas in a multicenter international cohort of 529 patients that underwent staged hepatectomy revealed that the Vauthey formula (estimate total liver volume = 18.51 × body weight + 191.8) provides the most accurate prediction of the actual future remnant liver volume.
The role of imaging in prediction of post-hepatectomy liver failure
2018, Clinical Imaging
Citation Excerpt :
Kishi et al. [95] used SLV rather than TLV to determine the FLR ratio [FLR ratio = (FLR / SLV) × 100%] for the following reasons: (1) TLV measurement may be significantly inaccurate in the presence of multiple tumors or intrahepatic bile duct dilatation [91, 96]; (2) tumors compressing or invading the portal vein or bile ducts induce liver atrophy, and measured TLV may not reflect accurate liver function; and (3) TLV does not provide a fixed estimate for total liver volume before and after portal vein embolism (PVE); in cases of atrophy without contralateral hypertrophy following PVE, the use of a smaller post-portal vein embolization TLV as denominator for calculation of the FLR ratio will falsely suggest hypertrophy. However, there is no consensus for determining SLV (Table 1) [89, 91, 97–102]. Moreover, the calculation of SLV can also be strongly influenced by the general condition of the patient.
Post-hepatectomy liver failure (PHLF) is not only a leading cause of mortality but also a leading cause of life-threatening complications in patients undergoing liver resection. The ability to accurately detect the emergence of PHLF represents a crucially important step. Currently, PHLF can be predicted by a comprehensive evaluation of biological, clinical, and anatomical parameters. With the development of new technologies, imaging methods including elastography, diffusion-weighted magnetic resonance imaging, and gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid-enhanced MRI play a more significant role in the pre-operative prediction and assessment of PHLF. In this review, we summarize the mainstream studies, with the aim of evaluating the role of imaging and improving the clinical value of existing scoring systems for predicting PHLF.
Liver volumetric and anatomic assessment in living donor liver transplantation: the role of modern imaging and artificial intelligence
2023, World Journal of Transplantation

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Liver transplantationTechnical issueEstimation of Standard Liver Volume for Liver Transplantation in the Chinese Population

Abstract

Introduction

Methods

Results

Conclusion

Section snippets

Patients

Subject Characteristics

Establishing a New Formula for SLV in Subjects With Normal Liver

Discussion

Hepatology

Transplant Proc

Liver Transpl

Preoperative measurement of segmental liver volume of donors for living related liver transplantation

Hepatology

Small graft for living donor liver transplantation

Ann Surg

Impact of graft size mismatching on graft prognosis in liver transplantation from living donors

Transplantation

Minimum graft size for successful living donor liver transplantation

Transplantation

Standard liver volume in the Caucasian population

Liver Transpl Surg

Estimation of standard liver volume for liver transplantation in the Korean population

Liver Transpl

Estimating liver weight of adults by body weight and gender

World J Gastroenterol

Liver transplantation
Technical issue
Estimation of Standard Liver Volume for Liver Transplantation in the Chinese Population