Accuracy of preoperative CT liver volumetry in living donor hepatectomy and its clinical implications

Sanjay Goja, Sanjay Kumar Yadav, Amardeep Yadav, Tarun Piplani, Amit Rastogi, Prashant Bhangui, Sanjiv Saigal, Arvinder Singh Soin

Abstract

Background: An accurate preoperative volumetric assessment of donor liver is essential for successful living donor liver transplant by ensuring adequate remnant and graft recipient weight ratio (GRWR).
Methods: The study cohort consisted of 744 right lobe (RL), 65 left lobe (LL) and 33 left lateral sector (LLS) grafts from July 2010 to January 2014. A semi-automated interactive commercial software called AW Volume share 6 was used for volumetry. Bland Altman plot was used for assessing the agreement between estimated graft weight (EGW) and actual graft weight (AGW).
Results: There was no statistically significant difference between EGW and AGW for RL graft weight (722±134 vs. 717±126 gm; P=0.06). Although Bland Altman graph showed that 95% limits of agreement was more in LL (−164 to +110) than RL (−156 to +147) and LLS grafts (−137 to +239), CT scan significantly overestimated LL graft weight (EGW =460±118 gm vs. AGW =433±102 gm; P=0.003) and underestimated LLS graft weight (EGW =203±48 gm vs. AGW =254±49 gm; P<0.001).
Conclusions: CT volumetry overestimate LL graft and un-derestimate LLS graft weight. This should be factored in when selecting LL graft by taking higher GRWR.