Direct measurement of graft and recipient liver fossa size by computed tomography for avoiding problems due [correction of clue] to large graft size in living-related liver transplantation.

We investigated the incidence and manifestation of problems associated with large graft size in living-related liver transplantations and assessed the usefulness of determining volume and dimensions of the graft and recipient's liver fossa by computed tomography to indicate the risk. Five of 150 living related liver transplantations had grafts that were too large, resulting in difficulty in primary abdominal closure or in sudden worsening of hemodynamics during primary closure. No significant difference existed in recipient age, sex, body weight, selection of the graft segment, hepatic vein reconstruction, recipient resected liver weight, graft volumetry value, the ratio of body weight of donor relative to recipient, and the percentage of graft weight relative to recipient body weight, between the groups with and without these problems. Mean +/- SEM of maximal dimensional ratio, defined as the maximum of the ratios of 3 dimensions of the graft relative to recipient liver fossa, were 2.36 +/- 0.64 for patients with grafts that were too large and 1.00 +/- 0.02 for the cases without size problems. The mean +/- SEM of liver fossa index, defined as the product of 3 dimensions of recipient liver fossa, were (25.03 +/- 7.18) x 10(4) mm3 and (127.54 +/- 5.07) x 10(4) mm3, respectively. These two indices clearly indicated the risk of problems due to large graft size, and will help to protect recipients and provide a basis for evaluating graft size in reductions.