Department of Transplantation, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
Department of General Surgery, The Third People's Hospital of Yangzhou, Yangzhou 225126, Jiangsu Province, China.
World J Gastroenterol. 2023 Nov 28;29(44):5894-5906. doi: 10.3748/wjg.v29.i44.5894.
Donor-recipient size mismatch (DRSM) is considered a crucial factor for poor outcomes in liver transplantation (LT) because of complications, such as massive intraoperative blood loss (IBL) and early allograft dysfunction (EAD). Liver volumetry is performed routinely in living donor LT, but rarely in deceased donor LT (DDLT), which amplifies the adverse effects of DRSM in DDLT. Due to the various shortcomings of traditional manual liver volumetry and formula methods, a feasible model based on intelligent/interactive qualitative and quantitative analysis-three-dimensional (IQQA-3D) for estimating the degree of DRSM is needed.
To identify benefits of IQQA-3D liver volumetry in DDLT and establish an estimation model to guide perioperative management.
We retrospectively determined the accuracy of IQQA-3D liver volumetry for standard total liver volume (TLV) (sTLV) and established an estimation TLV (eTLV) index (eTLVi) model. Receiver operating characteristic (ROC) curves were drawn to detect the optimal cut-off values for predicting massive IBL and EAD in DDLT using donor sTLV to recipient sTLV (called sTLVi). The factors influencing the occurrence of massive IBL and EAD were explored through logistic regression analysis. Finally, the eTLVi model was compared with the sTLVi model through the ROC curve for verification.
A total of 133 patients were included in the analysis. The Changzheng formula was accurate for calculating donor sTLV ( = 0.083) but not for recipient sTLV ( = 0.036). Recipient eTLV calculated using IQQA-3D highly matched with recipient sTLV ( = 0.221). Alcoholic liver disease, gastrointestinal bleeding, and sTLVi > 1.24 were independent risk factors for massive IBL, and drug-induced liver failure was an independent protective factor for massive IBL. Male donor-female recipient combination, model for end-stage liver disease score, sTLVi ≤ 0.85, and sTLVi ≥ 1.32 were independent risk factors for EAD, and viral hepatitis was an independent protective factor for EAD. The overall survival of patients in the 0.85 < sTLVi < 1.32 group was better compared to the sTLVi ≤ 0.85 group and sTLVi ≥ 1.32 group ( < 0.001). There was no statistically significant difference in the area under the curve of the sTLVi model and IQQA-3D eTLVi model in the detection of massive IBL and EAD (all > 0.05).
IQQA-3D eTLVi model has high accuracy in predicting massive IBL and EAD in DDLT. We should follow the guidance of the IQQA-3D eTLVi model in perioperative management.
供体-受体大小不匹配（DRSM）被认为是肝移植（LT）中预后不良的关键因素，因为它会导致大量术中失血（IBL）和早期移植物功能障碍（EAD）等并发症。活体供体 LT 中常规进行肝体积测量，但在尸体供体 LT（DDLT）中很少进行，这放大了 DRSM 在 DDLT 中的不良影响。由于传统手动肝体积测量和公式方法存在各种缺陷，因此需要一种基于智能/交互式定性和定量分析三维（IQQA-3D）的可行模型来估计 DRSM 程度。
确定 IQQA-3D 肝体积测量在 DDLT 中的益处，并建立一个估计模型以指导围手术期管理。
我们回顾性确定了 IQQA-3D 肝体积测量对标准总肝体积（TLV）（sTLV）的准确性，并建立了估计 TLV（eTLV）指数（eTLVi）模型。使用供体 sTLV 与受体 sTLV（称为 sTLVi）绘制受试者工作特征（ROC）曲线，以检测 DDLT 中大量 IBL 和 EAD 的最佳截断值。通过 logistic 回归分析探讨影响大量 IBL 和 EAD 发生的因素。最后，通过 ROC 曲线比较 eTLVi 模型和 sTLVi 模型进行验证。
共纳入 133 例患者进行分析。Changzheng 公式对计算供体 sTLV 是准确的（ = 0.083），但对受体 sTLV 则不准确（ = 0.036）。使用 IQQA-3D 计算的受体 eTLV 与受体 sTLV 高度匹配（ = 0.221）。酒精性肝病、胃肠道出血和 sTLVi > 1.24 是大量 IBL 的独立危险因素，药物性肝衰竭是大量 IBL 的独立保护因素。供体男性-受体女性组合、终末期肝病模型评分、sTLVi ≤ 0.85 和 sTLVi ≥ 1.32 是 EAD 的独立危险因素，病毒性肝炎是 EAD 的独立保护因素。sTLVi 在 0.85 < sTLVi < 1.32 组的患者总生存率明显优于 sTLVi ≤ 0.85 组和 sTLVi ≥ 1.32 组（< 0.001）。sTLVi 模型和 IQQA-3D eTLVi 模型在检测大量 IBL 和 EAD 方面的曲线下面积无统计学差异（均> 0.05）。
IQQA-3D eTLVi 模型在预测 DDLT 中的大量 IBL 和 EAD 方面具有较高的准确性。我们应该根据 IQQA-3D eTLVi 模型在围手术期管理中的指导进行。
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