CT liver volumetry in living donor liver transplantation (approach)

CT liver volumetry in living donor liver transplantation is essential imaging studies in preoperative assessment.

Liver volumetry is performed for the donor liver to calculate the graft volume and remnant liver volume. Preoperative measurement of liver volume is important to avoid graft mismatch. Donor-recipient graft mismatch has two forms:

• overestimation of the donor’s standard liver volume resulting in excess hepatic resection and consequent liver failure
• underestimation of the recipient's standard liver volume resulting in small-for-size graft syndrome

The graft volume is measured by either graft recipient weight ratio (GRWR), or the ratio of graft volume relative to the standard liver volume of the recipient (GV/SLV). GRWR must be > 0.8% and/or GV/SLV > 35%. The remnant liver volume must be >30% of the whole liver volume. The gold standard method for preoperative liver volumetry is manual CT volumetry

Radiology report

CT volumetry

The following are typically important to be included in the report (volumes in cm³ or grams):

• total liver volume
• right lobe volume with MHV
• right lobe volume without MHV
• residual left lobe with MHV: volume and percentage of the whole liver volume
• residual left lobe without MHV: volume and percentage of the whole liver volume

Graft to recipient weight ratio (GRWR)

• GRWR = graft volume in kg / recipient weight in kg

Two ratios are calculated:

• if graft is right lobe with MHV
• if graft is right lobe without MHV