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Liver Volume in the Cirrhotic Patient: Does Size Matter?

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Abstract

Background

While it is established that cirrhosis results in a decrease in liver volume (LV), whether LV itself predicts patient survival is unknown. We hypothesize that estimated LV is an important prognostic indicator in patients with cirrhosis.

Methods

Data was gathered retrospectively from consecutive patients evaluated for a liver transplant from January 2001 to June 2006. Of 500 patients identified, 323 patients met both inclusion and exclusion criteria. LV per ideal body weight (IBW) was used to correct for body size, and LV/IBW was stratified by median split for survival analyses. Patients were classified into one of three clinical groups: hepatocellular disease (n = 229), cholestatic disease (n = 56), and miscellaneous (n = 38). One of three possible clinical outcomes (survival, liver transplantation, or death) was recorded during the 5-year follow-up, the latter two grouped together as “transplant/death.”

Results

Transplant/death occurred in 283 (88 %) subjects. Overall, there was a significant increase in transplant/death in those with lower LV/IBW (χ 2 = 5.27, p = 0.022). When considering the subset with hepatocellular disease, lower LV/IBW was a robust predictor of transplant/death (χ 2 = 9.62, p = 0.002). In multivariate analyses, the LV/IBW trended toward predicting transplant/death (ExpB = 0.943, p = 0.053) independent of Model for End stage Liver Disease (MELD) (ExpB = 1.13, p = 0.001).

Discussion

LV has important predictive value in patients with cirrhosis from hepatocellular disease. This observation appears to be independent of MELD, suggesting LV may impart important prognostic information that is not captured by the MELD score alone. Thus, LV may serve as an important adjunct to the MELD score in patients with hepatocellular disease.

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References

  1. Lin XZ, Sun YN, et al. Liver volume in patients with or without chronic liver diseases. Hepatogastroenterology. 1998;45:1069–1074.

    CAS  PubMed  Google Scholar 

  2. Zhu JY, Leng XS, et al. Measurement of liver volume and its clinical significance in cirrhotic portal hypertensive patients. World J Gastroenterol. 1999;5:525–526.

    PubMed  Google Scholar 

  3. Yamagishi Y, Saito H, et al. A new prognostic formula for adult acute liver failure using computer tomography-derived hepatic volumetric analysis. J Gastroenterol. 2009;44:615–623.

    Article  PubMed  Google Scholar 

  4. Kubota K, Makuuchi M, Kusaka K, et al. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology. 1997;26:1176–1181.

    CAS  PubMed  Google Scholar 

  5. Yanaga K, Honda H, Ikeda Y, Nishizaki AT, Yamamoto K, Sugimachi K. Significance of liver size in hepatic surgery. HPB Surg. 1997;10:195–200.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Tu R, Xia LP, Yu AL, Wu L. Assessment of hepatic functional reserve by cirrhosis grading and liver volume measurement using CT. World J Gastroenterol. 2007;13:3956–3961.

    PubMed  Google Scholar 

  7. Kamath PS, Wiesner RH, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33:464.

    Article  CAS  PubMed  Google Scholar 

  8. Wiesner, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003;124:91–96.

    Article  PubMed  Google Scholar 

  9. Luca A, Angermayr B, Bertolini G, et al. An integrated MELD model including serum sodium and age improves the prediction of early mortality in patients with cirrhosis. Liver Transpl. 2007;13:1174.

    Article  PubMed  Google Scholar 

  10. Biggins SW, Kim WR, Terrault NA, et al. Evidence-based incorporation of serum sodium concentration into MELD. Gastroenterology. 2006;130:1652.

    Article  PubMed  Google Scholar 

  11. Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359:1018.

    Article  CAS  PubMed  Google Scholar 

  12. Sharma P, Schaubel DE, Sima CS, Merion RM, Lok AS. Re-weighting the model for end-stage liver disease score components. Gastroenterology. 2008;135:1575.

    Article  PubMed  Google Scholar 

  13. Leise MD, Kim WR, Kremers WK, Larson JJ, Benson JT, Therneau TM. A revised model for end-stage liver disease optimizes prediction of mortality among patients awaiting liver transplantation. Gastroenterology. 2011;140:1952.

    Article  PubMed  Google Scholar 

  14. Luca A, Angermayr B, Bertolini G, et al. An integrated MELD model including serum sodium and age improves the prediction of early mortality in patients with cirrhosis. Liver Transpl. 2007;13:1174.

    Article  PubMed  Google Scholar 

  15. Caldwell SH, deLange EE, Gaffey MJ, et al. Accuracy and significance of pretransplant liver volume measured by magnetic resonance imaging. Liver Transpl Surg. 1996;2:438–442.

    Google Scholar 

  16. MacSween, RNM. Alcoholic liver disease. Pathology of the Liver. Edinburgh: Churchill Livingstone; 1994:317–348.

  17. MacSween, RNM. Chronic hepatitis. Pathology of the Liver. Edinburgh: Churchill Livingstone; 1994:349–395.

  18. MacSween, RNM. Diseases of the intrahepatic bile ducts. Pathology of the Liver. Edinburgh: Churchill Livingstone; 1994:477–512.

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Acknowledgments

Research support was provided from the Foundation for the Barnes-Jewish Hospital, Fund 4359-30 (JSC), and NIH K23 DK084113-03 (GSS).

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Washington University School of Medicine, 660 South Euclid, Campus Box 8124, St. Louis, MO, USA

    Michael T. Hagan, Gregory S. Sayuk, Mauricio Lisker-Melman, Kevin M. Korenblat, Thomas A. Kerr & Jeffrey S. Crippin

  2. Department of General Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St. Louis, MO, 63110, USA

    William C. Chapman

Authors
  1. Michael T. Hagan
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  2. Gregory S. Sayuk
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  3. Mauricio Lisker-Melman
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  4. Kevin M. Korenblat
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  5. Thomas A. Kerr
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  6. William C. Chapman
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  7. Jeffrey S. Crippin
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Corresponding author

Correspondence to Jeffrey S. Crippin.

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Hagan, M.T., Sayuk, G.S., Lisker-Melman, M. et al. Liver Volume in the Cirrhotic Patient: Does Size Matter?. Dig Dis Sci 59, 886–891 (2014). https://doi.org/10.1007/s10620-014-3038-1

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  • DOI: https://doi.org/10.1007/s10620-014-3038-1

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