Evaluation of standard liver volume formulae for Chinese adults

AIM:To evaluate different standard liver volume (SLV) formula and verify the applicability of the formulae for Chinese adults.METHODS: Data from 70 cases of living donor liver transplantation (LDLT) performed at our transplantation centers between January 2008 and April 2009 were analyzed. SLV was estimated using our recently reported formula [the Chengdu formula: SLV (mL)=11.5×body weight (kg) + 334] and other reported formulae used for Chinese adults. Actual intraoperative liver volumes were obtained from a review of the patients' medical records.RESULTS: The actual right liver volume was not significantly different from the estimated right liver volume determined by the Chengdu formula, but was significantly smaller than estimates using the Heinemann, Urata, Vauthey, and Lee formulae (P<0.01), and signif icantly larger than estimates using the Fan formula (P<0.05).CONCLUSION: The Chengdu formula was demonstrated to be reliable by its application in LDLT.

New formula for predicting standard liver volume in Chinese adults

AIM To obtain a reference range of morphological indices and establish a formula to accurately predict standard liver volume(SLV) in Chinese adults.METHODS Computed tomography(CT)-estimated total liver volume(CTLV) was determined in 369 Chinese adults. Age,sex,body weight,body height,body mass index,and body surface area(BSA) were recorded using CT. Total splenic volume,portal venous diameter(PVD),splenic venous diameter(SVD),and portal venous cross-sectional area(PVCSA) were also measured by CT. Stepwise multiple linear regression analysis was performed to evaluate the impact of each parameter on CTLV and to develop a new SLV formula. The accuracy of the new formula was compared with the existing formulas in a validation group.RESULTS The average CTLV was 1205.41 ± 257.53 cm3(range,593.80-2250.10 cm3). The average of PVD,SVD and PVCSA was 9.34 ± 1.51 mm,7.40 ± 1.31 mm and 173.22 ± 48.11 mm2,respectively. The CT-estimated splenic volume of healthy adults varied markedly(range,46.60-2892.30 cm3). Sex,age,body height,body weight,body mass index,and BSA were significantly correlated with CTLV. BSA showed the strongest correlation(r = 0.546,P < 0.001),and was used to establish a new model for calculating SLV: SLV(cm3) = 758.259 × BSA(m2)-124.272(R2 = 0.299,P < 0.001). This formula also predicted CTLV more accurately than the existing formulas,but overestimated CTLV in elderly subjects > 70 years of age,and underestimated liver volume when CTLV was > 1800 cm3.CONCLUSION Our new BSA-based formula is more accurate than other formulas in estimating SLV in Chinese adults.

Clinical study of standard residual liver volume and transient elastography in predicting poor prognosis of patients after hemihepatectomy

BACKGROUND Liver cancer resection,especially in patients with hemihepatectomy or extended hemihepatectomy,often leads to poor prognosis,such as liver insufficiency and even liver failure and death,because the standard residual liver volume(SRLV)cannot be fully compensated after surgery.AIM To explore the risk factors of poor prognosis after hemihepatectomy for hepatocellular carcinoma and evaluate the application value of related prognostic approaches.METHODS The clinical data of 35 patients with primary liver cancer in Nantong Third People's Hospital from February 2016 to July 2020 were retrospectively analyzed.The receiver operating characteristic curve was created using medcac19.0.4 to compare the critical values of the SRLV in different stages of liver fibrosis after hemihepatectomy with those of liver dysfunction after hemihepatectomy.It was constructed by combining the Child-Pugh score to evaluate its application value in predicting liver function compensation.RESULTS The liver stiffness measure(LSM)value and SRLV were associated with liver dysfunction after hemihepatectomy.Logistic regression analysis showed that an LSM value≥25 kPa[odds ratio(OR)=6.254,P<0.05]and SRLV≤0.290 L/m^(2)(OR=5.686,P<0.05)were independent risk factors for postoperative liver dysfunction.The accuracy of the new liver reserve evaluation model for predicting postoperative liver function was higher than that of the Child-Pugh score(P<0.05).CONCLUSION SRLV and LSM values can be used to evaluate the safety of hemihepatectomy.The new liver reserve evaluation model has good application potential in the evaluation of liver reserve function after hemihepatectomy.

Liver and spleen volume variations in patients with hepatic fibrosis

AIM： To study the liver and spleen volume variations in hepatic fibrosis patients at different histopathological stages. METHODS： Multidetector computed tomography （MDCT） scan was performed in 85 hepatic fibrosis patients. Liver volume （LV） and spleen volume （SV） were measured. Fifteen healthy individuals served as a control group （SO）. The patients were divided into stage 1 （S1） group （n = 34）, stage 2 （S2） group （n = 25）, stage 3 （S3） group （n = 16）, and stage 4 （S4） group （n = 10） according to their histopathological stage of liver fibrosis. RESULTS： The LV and standard LV （SLV） had a tendency to increase with the severity of fibrosis, but no statistical difference was observed in the 5 groups （LV： F = 0.245, P = 0.912; SLV： F = 1.902, P = 0.116）. The SV was gradually increased with the severity of fibrosis, and a statistically significant difference in SV was observed among the 5 groups （P 〈 0.01）. The LV/SV ratio and SLV/SV ratio were gradually decreased with the aggravation of hepatic fibrosis, and statistically significant differences in both LV/SV and SLV/SV were found among the 5 groups （P 〈 0.01）.CONCLUSION： The absence of obvious LV reduction in patients with chronic liver disease may be a morphological index of patients without liver cirrhosis. The SV is related to the severity of fibrosis, and the spleen of patients with advanced fibrosis is enlarged evidently. The LV/SV ratio and SLV/SV ratio are of a significant clinical value in the diagnosis of advanced liver fibrosis.

Predicting liver function after hemihepatectomy in patients with hepatocellular carcinoma using different modalities

In response to Dr.Yue et al's study on prognostic factors for post-hemihep-atectomy outcomes in hepatocellular carcinoma(HCC)patients,this critical review identifies methodological limitations and proposes enhancements for future research.While the study identifies liver stiffness measure and standard residual liver volume as potential predictors,concerns regarding small sample size,reliance on biochemical markers for safety assessment,and inadequate ad-justment for confounding variables are raised.Recommendations for rigorous methodology,including robust statistical analysis,consideration of confounding factors,and selection of outcome measures with clinical components,are proposed to strengthen prognostic assessments.Furthermore,validation of novel evaluation models is crucial for enhancing clinical applicability and advancing understanding of postoperative outcomes in patients with HCC undergoing hem-ihepatectomy.

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.

Clinical study on safety of adult-to-adult living donor liver transplantation in both donors and recipients

AIM： TO investigate the safety of adult-to-adult living donor liver transplantation （A-A LDLT） in both donors and recipients. METHODS： From January 2002 to July 2006, 50 cases of A-A LDLT were performed at West China Hospital, Sichuan University, consisting of 47 cases using right lobe graft without middle hepatic vein （HHV）, and 3 cases using dual grafts （one case using two left lobe, 2 using one right lobe and one left lobe）. The most common diagnoses were hepatitis B liver cirrosis, 30 （60%） cases; and hepatocellular carcinoma, 15 （30%） cases in adult recipients. Among them, 10 cases had the model of end-stage liver disease （HELD） with a score of more than 25. Donor screening consisted of reconstruction of the hepatic blood vessels and biliary system with 3-dimension computed tomography and volumetry of whole liver and right liver volume. Various improved surgical techniques were adopted in the procedures for both donors and recipients. RESULTS： Forty-nine right lobes and 3 left lobes （2 left lobe grafts for 1 recipient, 1 left lobe graft for 1 recipient who had received right lobe graft donated by relative living donor） were obtained from 52 living donors. The 49 right lobe grafts, without HHV, weighed 400 g-850 g （media 550 g）, and the ratio of graft volume to recipient standard liver volume （GV/SLV） ranged from 31.74% to 71.68% （mean 45.35%）. All donors＇ remnant liver volume was over 35% of the whole liver volume. There was no donor mortality. With a follow- up of 2-52 mo （media 9 too）, among 50 adult recipients, complications occurred in 13 （26%） cases and 4 （8%） died postoperatively within 3 mo. Their 1-year actual survival rate was 92%.CONCLUSION： When preoperative CT volumetry shows volume of remnant liver is more than 350, the ratio of right lobe graft to recipients standard liver volume exceeding 40%, A-A LDLT using right lobe graft without MHV should be a very safe procedure for both donors and recipients, otherwise dual grafts liver transplantation should be considered.

A new scoring system for assessment of liver function after successful hepatectomy in patients with hepatocellular carcinoma

BACKGROUND:Whether a major liver resection is safe has been judged mainly from the patient’s hepatic reserve.However,a safe limit for liver resection does not exist yet.This study aimed to construct a new scoring system as a guide to determine a safe limit for liver resection and avoid liver dysfunction after hepatectomy.METHODS:Eighty-six patients with hepatocellular carcinoma who had undergone hepatectomy in West China Hospital from March 2007 to June 2010 were reviewed.The patients were classified according to the levels of total bilirubin after hepatectomy and the parameters in the perioperative period were compared.Receiver operating characteristic (ROC) analysis was made to assess the liver function compensatory (LFC) value to predict liver dysfunction of the patients after hepatectomy.LFC value is defined as the preoperative KICG value×22.487+standard remnant liver volume (SRLV)×0.020.RESULTS:Patients were classified into group Ⅰ (normal group,n=69) and group Ⅱ (with total bilirubin >85.5 μmol/L for 7 days after hepatectomy,n=17) based on the levels of total bilirubin after hepatectomy.Group II was further divided into two subgroups:recovered subgroup (n=14) and fatal subgroup (n=3).There were no significant differences in preoperative data or intraoperative findings except the indocyanine green test parameters (KICG and ICG R15) and SRLV.ROC analysis showed that the sensitivity and specificity of an LFC value ≤13.01 were 94.1% and 82.6% respectively for predicting liver dysfunction of the patients after hepatectomy.CONCLUSIONS:The LFC value appears to be a good predictor of postoperative liver dysfunction in patients who undergo hepatectomy for HCC.An expected LFC value of 13.01 seems to be a safe limit for liver resection.

Estimating liver weight of adults by body weight and gender

AIM： To estimate the standard liver weight for assessing adequacies of graft size in live donor liver transplantation and remnant liver in major hepatectomy for cancer. METHODS： In this study, anthropometric data of body weight and body height were tested for a correlation with liver weight in 159 live liver donors who underwent donor right hepatectomy including the middle hepatic vein. Liver weights were calculated from the right lobe graft weight obtained at the back table, divided by the proportion of the right lobe on the computed tomography. RESULTS： The subjects, all Chinese, had a mean age of 35.8 ± 10.5 years, and a female to male ratio of 118：41. The mean volume of the right lobe was 710.14 ±131.46 mL and occupied 64.55%±4.47% of the whole liver on computed tomography. Right lobe weighed 598.90±117.39 g and the estimated liver weight was 927.54 ± 168.78 g. When body weight and body height were subjected to multiple stepwise linear regression analysis, body height was found to be insignificant. Females of the same body weight had a slightly lower liver weight. A formula based on body weight and gender was derived： Estimated standard liver weight （g）=218＋BW （kg）× 12.3＋gender×51 （R^2 = 0.48） （female=0, male= 1）. Based on the anthropometric data of these 159 subjects, liver weights were calculated using previously published formulae derived from studies on Caucasian, .lapanese, Korean, and Chinese. All formulae overestimated liver weights compared to this formula. The Japanese formula overestimated the estimated standard liver weight （ESLW） for adults less than 60 kg.CONCLUSION： A formula applicable to Chinese males and females is available. A formula for individual races appears necessary.