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World Journal of Surgery

, Volume 42, Issue 1, pp 218–224 | Cite as

Younger Age is an Independent Factor for Graft Weight Overestimation: Analysis of the Clinical Impact on Recipient Outcomes in 340 Japanese Living Liver Donors

  • Toshihiro Kitajima
  • Toshimi Kaido
  • Tetsuya Tajima
  • Tadahiro Uemura
  • Yasuhiro Fujimoto
  • Andrea Schenk
  • Shinji Uemoto
Original Scientific Report
  • 143 Downloads

Abstract

Background

Accurate preoperative estimation of graft weight is essential for improving outcomes in living donor liver transplantation.

Methods

This retrospective study sought to identify factors associated with graft weight overestimation. From April 2006 to August 2015, 340 living donors were assigned to no-overestimate (n = 284) or overestimate (n = 56) groups. We defined graft weight overestimation as a discrepancy ≥15% between estimated graft volume and actual graft weight. Donor data were compared, and associated factors for graft weight overestimation were analyzed. Recipient outcomes were compared between the groups according to identified factors.

Results

Donors were significantly younger in the overestimate group than in the no-overestimate group (35.0 vs. 46.0 years; p < 0.001). Multivariate analysis identified donor age <45 years as an independent risk factor for graft weight overestimation (odds ratio 2.068; 95% confidence interval 1.114–3.839; p = 0.021). Among recipients with donors <45 years (n = 168), incidence of small-for-size dysfunction (SFSD) was significantly higher in the overestimate group than in the no-overestimate group (7/37 patients vs. 7/131 patients; p = 0.016); no significant difference was observed among recipients with donors ≥45 years (n = 172). First-year mortality was lower in SFSD recipients with donors <45 years (14.3 vs. 60.9%, p = 0.007). Among recipients with younger donors, graft survival was not significantly different between overestimate and no-overestimate groups.

Conclusions

Younger donor age was an independent risk factor for graft weight overestimation leading to SFSD in recipients, but did not impair graft survival.

Notes

Compliance with ethical standards

Conflict of interest

All authors of this manuscript have no conflicts of interest.

References

  1. 1.
    Chen YS, Cheng YF, De Villa VH et al (2003) Evaluation of living liver donors. Transplantation 75:S16–S19CrossRefPubMedGoogle Scholar
  2. 2.
    Kitajima T, Kaido T, Iida T et al (2016) Left lobe graft poses a potential risk of hepatic venous outflow obstruction in adult living donor liver transplantation. Liver Transpl 22:785–795CrossRefPubMedGoogle Scholar
  3. 3.
    Urata K, Kawasaki S, Matsunami H et al (1995) Calculation of child and adult standard liver volume for liver transplantation. Hepatology 21:1317–1321CrossRefPubMedGoogle Scholar
  4. 4.
    Kokudo T, Hasegawa K, Uldry E et al (2015) A new formula for calculating standard liver volume for living donor liver transplantation without using body weight. J Hepatol 63:848–854CrossRefPubMedGoogle Scholar
  5. 5.
    Yoshizumi T, Gondolesi GE, Bodian CA et al (2003) A simple new formula to assess liver weight. Transpl Proc 35:1415–1420CrossRefGoogle Scholar
  6. 6.
    Wang F, Pan KT, Chu SY et al (2011) Preoperative estimation of the liver graft weight in adult right lobe living donor liver transplantation using maximal portal vein diameters. Liver Transpl 17:373–380CrossRefPubMedGoogle Scholar
  7. 7.
    Yoneyama T, Asonuma K, Okajima H et al (2011) Coefficient factor for graft weight estimation from preoperative computed tomography volumetry in living donor liver transplantation. Liver Transpl 17:369–372CrossRefPubMedGoogle Scholar
  8. 8.
    Sakamoto S, Uemoto S, Uryuhara K et al (2001) Graft size assessment and analysis of donors for living donor liver transplantation using right lobe. Transplantation 71:1407–1413CrossRefPubMedGoogle Scholar
  9. 9.
    Lee VS, Morgan GR, Teperman LW et al (2001) MR imaging as the sole preoperative imaging modality for right hepatectomy: a prospective study of living adult-to-adult liver donor candidates. AJR Am J Roentgenol 176:1475–1482CrossRefPubMedGoogle Scholar
  10. 10.
    Schroeder T, Nadalin S, Stattaus J et al (2002) Potential living liver donors: evaluation with an all-in-one protocol with multi-detector row CT. Radiology 224:586–591CrossRefPubMedGoogle Scholar
  11. 11.
    Schroeder T, Malagó M, Debatin JF et al (2005) “All-in-one” imaging protocols for the evaluation of potential living liver donors: comparison of magnetic resonance imaging and multidetector computed tomography. Liver Transpl 11:776–787CrossRefPubMedGoogle Scholar
  12. 12.
    Salvalaggio PR, Baker TB, Koffron AJ et al (2005) Liver graft volume estimation in 100 living donors: measure twice, cut once. Transplantation 80:1181–1185CrossRefPubMedGoogle Scholar
  13. 13.
    Kayashima H, Taketomi A, Yonemura Y et al (2008) Accuracy of an age-adjusted formula in assessing the graft volume in living donor liver transplantation. Liver Transpl 14:1366–1371CrossRefPubMedGoogle Scholar
  14. 14.
    Iwasaki M, Takada Y, Hayashi M et al (2004) Noninvasive evaluation of graft steatosis in living donor liver transplantation. Transplantation 78:1501–1505CrossRefPubMedGoogle Scholar
  15. 15.
    Selle D, Preim B, Schenk A et al (2002) Analysis of vasculature for liver surgical planning. IEEE Trans Med Imaging 21:1344–1357CrossRefPubMedGoogle Scholar
  16. 16.
    Frericks BB, Caldarone FC, Nashan B et al (2004) 3D CT modeling of hepatic vessel architecture and volume calculation in living donated liver transplantation. Eur Radiol 14:326–333CrossRefPubMedGoogle Scholar
  17. 17.
    Radtke A, Sotiropoulos GC, Molmenti EP et al (2010) Computer-assisted surgery planning for complex liver resections: when is it helpful? A single-center experience over an 8-year period. Ann Surg 252:876–883CrossRefPubMedGoogle Scholar
  18. 18.
    Iida T, Ogura Y, Oike F et al (2010) Surgery-related morbidity in living donors for liver transplantation. Transplantation 89:1276–1282CrossRefPubMedGoogle Scholar
  19. 19.
    Inomata Y, Uemoto S, Asonuma K et al (2000) Right lobe graft in living donor liver transplantation. Transplantation 69:258–264CrossRefPubMedGoogle Scholar
  20. 20.
    Dahm F, Georgiev P, Clavien PA (2005) Small-for-size syndrome after partial liver transplantation: definition, mechanisms of disease and clinical implications. Am J Transpl 5:2605–2610CrossRefGoogle Scholar
  21. 21.
    Uemura T, Wada S, Kaido T et al (2016) How far can we lower graft-to-recipient weight ratio for living donor liver transplantation under modulation of portal venous pressure? Surgery 159:1623–1630CrossRefPubMedGoogle Scholar
  22. 22.
    Choukèr A, Martignoni A, Dugas M et al (2004) Estimation of liver size for liver transplantation: the impact of age and gender. Liver Transpl 10:678–685CrossRefPubMedGoogle Scholar
  23. 23.
    Friedman SL (1999) Cytokines and fibrogenesis. Semin Liver Dis 19:129–140CrossRefPubMedGoogle Scholar
  24. 24.
    McLean AJ, Cogger VC, Chong GC et al (2003) Age-related pseudocapillarization of the human liver. J Pathol 200:112–117CrossRefPubMedGoogle Scholar
  25. 25.
    Pomposelli JJ, Goodrich NP, Emond JC et al (2016) Patterns of early allograft dysfunction in adult live donor liver transplantation: the A2ALL experience. Transplantation 100:1490–1499CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Gaba RC, Knuttinen MG, Brodsky TR et al (2012) Hepatic steatosis: correlations of body mass index, CT fat measurements, and liver density with biopsy results. Diagn Interv Radiol 18:282–287PubMedGoogle Scholar
  27. 27.
    Kaido T, Mori A, Ogura Y et al (2011) Lower limit of the graft-to-recipient weight ratio can be safely reduced to 0.6% in adult-to-adult living donor liver transplantation in combination with portal pressure control. Transpl Proc 43:2391–2393CrossRefGoogle Scholar
  28. 28.
    Ogura Y, Hori T, El Moghazy WM et al (2010) Portal pressure <15 mm Hg is a key for successful adult living donor liver transplantation utilizing smaller grafts than before. Liver Transpl 16:718–728PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • Toshihiro Kitajima
    • 1
  • Toshimi Kaido
    • 1
  • Tetsuya Tajima
    • 1
  • Tadahiro Uemura
    • 1
  • Yasuhiro Fujimoto
    • 2
  • Andrea Schenk
    • 3
  • Shinji Uemoto
    • 1
  1. 1.Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of MedicineKyoto UniversityKyotoJapan
  2. 2.Department of Digestive SurgeryShizuoka City Shizuoka HospitalShizuokaJapan
  3. 3.Fraunhofer Institute for Medical Image Computing MEVISBremenGermany

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