Body Mass Index and Unenhanced CT as a Predictor of Hepatic Steatosis in Potential Liver Donors.

BACKGROUND: In living-donor liver transplantation, donor hepatic steatosis is crucial for both the donor and the recipient. Body mass index (BMI) and the unenhanced computed tomography liver attenuation index (CT LAI) are noninvasive methods to predict hepatic steatosis in living-donor liver candidates. AIM: To analyze the diagnostic accuracy of CT LAI in conjunction with different BMI values for macrovesicular steatosis in living-donor liver candidates. METHODS: A total of 264 potential liver donors were included. The diagnostic accuracy of 2 CT LAI cut-offs and 3 BMI cut-off values for the assessment of hepatic steatosis ≥15% and ≤5% was determined. RESULTS: Using CT LAI, the area under the receiver operating characteristic curve was 0.97 (95% CI = 0.89-0.99) for hepatic steatosis ≥15% in donors with BMI <25 kg/m2. For detecting hepatic steatosis ≥15%, a CT LAI ≤0 had specificities of 100%, 76.2%, and 55.6% and positive predictive values of 100%, 95.5%, and 93.5% for patients with BMI values <25 kg/m2, 25 to 29.9 kg/m2, and ≥30 kg/m2, respectively. According to logistic regression analyses, only CT LAI ≤0 was found to be independently associated with hepatic steatosis ≥15%. CONCLUSIONS: In donors with BMI <30 kg/m2 and a CT LAI value >6, liver biopsy might be avoided. Biopsy may be reserved solely for donors with CT LAI value >0 and BMI ≥30 kg/m2 as the diagnostic accuracy of computed tomography for predicting hepatic steatosis decreases with increasing BMI.

Does Multiple Bile Duct Anastomosis in Living Donor Liver Transplantation Affect the Postoperative Biliary Complications?

PURPOSE: The variation of multiple bile ducts in a living donor graft is not infrequent; however, the literature on the impact of the number of bile ducts on postoperative biliary complications is scarce. We investigated whether the number of biliary duct anastomoses affects the rate of postoperative biliary complications in patients undergoing living donor liver transplantation (LDLT). MATERIALS AND METHODS: Between January 2016 and January 2018, all patients who underwent LDLT were reviewed. The patients were divided into 2 groups according to the number bile duct anastomoses (single duct [group A, n = 78] or multiple ducts [group B, n = 94]). Data collection included demographic features, Child Pugh Score (CPS), graft-recipient weight ratio (GRWR), surgical data including technique of biliary anastomosis (duct-to-duct, duct-to-sheath, double duct-to-duct, and hepaticojejunostomy), and postoperative morbidity and mortality. RESULTS: The duct-to-duct anastomosis was the mostly commonly performed technique in group A, whereas double duct-to-duct and duct-to-sheath were significantly higher in group B. Operating time was quite high in group B compared to group A (438 ± 72 minutes vs 420 ± 61 minutes, respectively; P = .05). Regarding biliary complications (n = 40, 23.2%), the rates of biliary leakage (n = 17, 9.9%) and strictures (n = 25, 14.5%) were similar in both groups (P = .164 and .773, respectively). CPS was positively correlated (for Child B and C, odds ratio [OR]: 10.669 and 17.866, respectively), whereas GRWR was negatively correlated (OR: 9.530) with biliary stricture. Increased risk for bile leakage was observed in younger donors (OR: .929). Although overall mortality rate was 9.8% (n = 17), only 5 of the patients (29%) died of biliary complications. CONCLUSION: The number of biliary ducts and anastomoses did not affect the rate of complications. However, CPS, GRWR, and young donor age were found to be predisposing factors for postoperative biliary complications. Mortality was mostly based on the causes other than biliary complications.

Liver Graft Volume Estimation by Manual Volumetry and Software-Aided Interactive Volumetry: Which is Better?

PURPOSE: Estimation of graft volume is critical in living donor liver transplantation (LDLT). In this study, we aimed to evaluate the accuracy of software-aided automated computer tomography (CT) volumetry in the preoperative assessment of graft size for LDLT and to compare this method with manual volumetry. MATERIALS AND METHODS: Forty-one donors (27 men; 14 women) with a mean age in years ± standard deviation (28.4 ± 6.6) underwent contrast-enhanced CT prior to graft removal for LDLT. A liver transplant surgeon determined the weights of liver grafts using automated 3-dimensional volumetry software, and an abdominal radiologist specializing in liver imaging independently and blindly used the commercial interactive volumetry-assisted software on a viewing workstation to determine the liver volume on CT images. Both results were then compared to the weights of actual grafts obtained during surgery. Intraclass correlation coefficients were used to assess the consistency of numerical measurements and Pearson correlation coefficients were calculated to detect a linear relationship between numerical variables. To compare correlation coefficients, z scores were used. RESULTS: Regarding the right and left lobe graft volume estimation by the surgeon, there was a positive correlation between the results and actual graft weight (r = 0.834; P = .001; and r = 0.587; P = .001, respectively). Likewise, graft volume estimation by the radiologist for the right and left lobe was also positively correlated with the actual graft weight (r = 0.819; P = .001 and r = 0.626, P = .001, respectively). There was no significant difference between correlation coefficients (P = .836). CONCLUSION: Volumetric measurement of donor graft using 3-dimensional software provides comparable results to manual CT calculation of liver volume.