Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation, and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Clin Transplant. 2023 Jun;37(6):e14976. doi: 10.1111/ctr.14976. Epub 2023 Mar 23.
Various formulae have been used for the estimation of standard liver volume (SLV) in preparation for living donor liver transplantation (LDLT). However, these formulae have the disadvantage of being constructed using parameters that are substantially affected by the patient's condition. Here, we aimed to establish more precise formulae that are less affected by the general condition of the patient.
We analyzed the liver volumes of LDLT donors and patients with normal livers (total: n = 213) using the SYNAPSE VINCENT imaging analysis system, to develop new formulae. The accuracy of the new formulae were compared with those of existing formulae in a separate validation group of healthy patients (n = 200). The new formulae were also validated using 81 LDLT recipients to assess their utility for graft selection in LDLT.
Body surface area (BSA) and skeletal muscle mass index (SMI) independently affected total liver volume (TLV). We produced new formulae for SLV incorporating SMI: SLV = 32.2 × L3-SMI-466.9 for men, with R2 .92, and 25.7 × L3-SMI-55.97 for women, with R2 .79 (alongside a BSA formula with R2 .57), which provided the most accurate predictions of TLV in the validation group. A graft volume (GV)/SLV <.35, calculated using the new formulae, predicted the postoperative prognosis, including the development of small-for-size syndrome, sepsis, or acute rejection, significantly more effectively than GV/SLV using the previous formulae.
The newly developed L3-SMI-based formula is more accurate for the estimation of SLV than previously reported formulae, and may thus help to improve the safety of LDLT.
为了准备活体肝移植 (LDLT)，已经使用了各种公式来估计标准肝体积 (SLV)。然而，这些公式的缺点是使用的参数受到患者病情的极大影响。在这里，我们旨在建立受患者一般状况影响较小的更精确的公式。
我们使用 SYNAPSE VINCENT 成像分析系统分析 LDLT 供体和正常肝脏患者的肝体积（总数：n=213），以开发新的公式。在一组单独的健康患者（n=200）验证组中，比较新公式与现有公式的准确性。还使用 81 名 LDLT 受者验证了新公式，以评估它们在 LDLT 中用于移植物选择的效用。
体表面积 (BSA) 和骨骼肌质量指数 (SMI) 独立影响总肝体积 (TLV)。我们提出了包含 SMI 的 SLV 新公式：男性 SLV=32.2×L3-SMI-466.9，R2.92，女性 SLV=25.7×L3-SMI-55.97，R2.79（以及 R2.57 的 BSA 公式），这在验证组中提供了最准确的 TLV 预测。使用新公式计算的 GV/SLV <.35 比使用以前的公式更有效地预测术后预后，包括小肝综合征、败血症或急性排斥的发展。
与以前报道的公式相比，新开发的基于 L3-SMI 的公式更准确地估计 SLV，因此可能有助于提高 LDLT 的安全性。
