Presentation
A preoperative assessment study for a potential living donor for liver transplantation
Patient Data
These are axial CT cuts in hepatic venous phase used for CT volumetry, where hepatic veins appear opacified, using 8 mm slice thickness
Gall bladder dense stone is seen
These are post processing manual volumetry imaging of the liver.
Liver boundary is traced to exclude the surrounding structures/organs as well as vessels and hepatic fissures, then we summate the liver area on every single cut.
The volume of all cuts is summed to get the total and lobar volume of the liver.
We assume that the mean liver density equals 1 gm/ml i.e. the calculated volumes equals their respective weights.
CT volumetry report:
- total liver volume is 1361.72 cm3 (1.361 kgm).
- right lobe volume with MHV is 855.57 cm3 (0.855 kgm).
- right lobe volume without MHV is 802.83 cm3 (0.802 kgm).
- residual left lobe with MHV is 558.89 cm3 (0.558 kgm) = 41.04 %.
- residual left lobe without MHV is 506.15 cm3 ( 0.506 kgm) = 37.16 %.
- GRWR (Graft to Recipient weight ratio): (Recipient weight = 70 kg ).
- 1.14 (if graft is right lobe without MHV).
- 1.22 (if graft is right lobe with MHV)
Case Discussion
CT liver volumetry is an essential imaging study in preoperative assessment for living donor liver transplantation. An accurate preoperative estimate of the graft weight is vital to avoid small-for-size syndrome in the recipient and ensure donor safety after adult living donor liver transplantation.
The gold standard method for preoperative liver volumetry is manual CT volumetry.
The graft recipient weight ratio (GRWR) must be > 0.8% (in our case it is 1.14 if the graft is the right hepatic lobe without middle hepatic vein).
The remnant liver volume must be >30% of the whole liver volume (in our case it is 41.04% if the graft is the right hepatic lobe without middle hepatic vein).