Standard liver weight model in adult deceased donors with fatty liver: A prospective cohort study

BACKGROUND Standard liver weight(SLW)is frequently used in deceased donor liver transplantation to avoid size mismatches with the recipient.However,some deceased donors(DDs)have fatty liver(FL).A few studies have reported that FL could impact liver size.To the best of our knowledge,there are no relevant SLW models for predicting liver size.AIM To demonstrate the relationship between FL and total liver weight(TLW)in detail and present a related SLW formula.METHODS We prospectively enrolled 212 adult DDs from West China Hospital of Sichuan University from June 2019 to February 2021,recorded their basic information,such as sex,age,body height(BH)and body weight(BW),and performed abdominal ultrasound(US)and pathological biopsy(PB).The chi-square test and kappa consistency score were used to assess the consistency in terms of FL diagnosed by US relative to PB.Simple linear regression analysis was used to explore the variables related to TLW.Multiple linear regression analysis was used to formulate SLW models,and the root mean standard error and interclass correlation coefficient were used to test the fitting efficiency and accuracy of the model,respectively.Furthermore,the optimal formula was compared with previous formulas.RESULTS Approximately 28.8%of DDs had FL.US had a high diagnostic ability(sensitivity and specificity were 86.2%and 92.9%,respectively;kappa value was 0.70,P<0.001)for livers with more than a 5%fatty change.Simple linear regression analysis showed that sex(R2,0.226;P<0.001),BH(R2,0.241;P<0.001),BW(R2,0.441;P<0.001),BMI(R2,0.224;P<0.001),BSA(R2,0.454;P<0.001)and FL(R2,0.130;P<0.001)significantly impacted TLW.In addition,multiple linear regression analysis showed that there was no significant difference in liver weight between the DDs with no steatosis and those with steatosis within 5%.Furthermore,in the context of hepatic steatosis,TLW increased positively(nonlinear);compared with the TLW of the non-FL group,the TLW of the groups with hepatic steatosis within 5%,between 5%and 20%and more than 20%increased by 0 g,90 g,and 340 g,respectively.A novel formula,namely,-348.6+(110.7 x Sex[0=Female,1=Male])+958.0 x BSA+(179.8 x FLUS[0=No,1=Yes]),where FL was diagnosed by US,was more convenient and accurate than any other formula for predicting SLW.CONCLUSION FL is positively correlated with TLW.The novel formula deduced using sex,BSA and FLUS is the optimal formula for predicting SLW in adult DDs.

Developing a new nomogram to predict early allograft dysfunction after liver transplantation:a nudge in the right direction

Liver transplantation(LTx)is an established option for the treatment of end-stage liver disease,acute liver failure,and hepatic malignancies(1-3).Despite significant advances in clinical practice and scientific research on LTx,liver allograft dysfunction remains a significant clinical problem.Early allograft dysfunction(EAD)is a milder form of primary graft dysfunction that correlates with postoperative complications,higher mortality rates,and decreased graft survival(4).The frequency of EAD ranges from 15%to 30%after LTx from donors after brain death(DBD),reaching 68.4%after LTx from donors after cardiac death(DCD)(5).For living donor liver transplantation(LDLT),the prevalence of EAD is comparatively low,accounting for 18.1%of the recipients in our transplant center(4).

Utilization of hepatitis B virus-positive allografts in liver transplantation:a new arrow to the bowstring for expanding the donor pool?

Liver disease accounts for approximately 2 million deaths per year worldwide,including 1 million due to complications of cirrhosis and 1 million due to viral hepatitis and hepatocellular carcinoma(HCC)(1).Liver transplantation(LTx)is the definitive management for end-stage liver disease and HCC in both children and adults.However,the number of liver transplant candidates on the waiting list exceeds that of available allografts.Approximately one-third of the global population has serological evidence of past or current hepatitis B virus(HBV)infection,including 250 million people with chronic HBV infection.The concept of using HBV-positive liver allografts has been implemented to expand the organ pool worldwide(2).Especially in regions with high or intermediate prevalence of HBV infection,these allografts can be an optimal choice for LTx recipients.Over the decades,LTx from HBV-exposed allografts has shifted from the first case in the 1980s to expanded practice supported by positive outcomes,particularly with the availability of safe and effective clinical therapies(3).