Evaluation of the difference between preoperative estimated liver volume and intraoperative actual graft volume in living donor liver transplantation and its effect on the recipient

Background
Living donor liver transplantation (LDLT) is the only treatment for patients with end-stage liver diseases and liver tumors in Egypt, although in LDLT, there are two paradoxical concerns of adult LDLT: one is the size of liver remnant for the donor, and another is the minimum graft size for the recipient, in considering living donor safety and recipients’ prognosis.
Objective
In this retrospective study, we evaluated the difference between the preoperative estimated liver volume and the actual intraoperative graft volume in donors who underwent right hepatectomies and analyzed the effect of age, BMI, and sex on this difference and its effect on the recipient regarding small-for-size syndrome (SFSS).
Patients and methods
Our study was conducted on 200 donors who underwent right hepatectomies performed at Ain Shams Center for Organ Transplantation in Cairo between 2016 and 2020. We evaluated the preoperative liver graft volume by computed tomography volumetry and the actual graft volume intraoperatively and following up the recipient to detect the effect of graft volume difference (delta volume) on the recipient in regard to SFSS and factors affecting it.
Results
The mean preoperatively estimated graft volume was 922.52 ± 157.53 g, and the mean intraoperatively measured actual graft volume was 796.15 ± 147.28 g. There was a statistically significant difference (=0.000). Age of the donor had a significant effect on the discrepancy between the predicted and actual graft volume, whereas sex and BMI did not. The higher the BMI of the recipient, the more was the incidence of SFSS. Glypressin with or without splenectomy decreases SFSS manifestation after LDLT in patients diagnosed with SFSS.
Conclusion
Proper preoperative selection of the donor and estimation of graft volume should be performed accurately to prevent donor morbidity and mortality and to decrease the incidence of SFSS in recipients. We should put into consideration that there is a difference of 13.7% between the predicted and the actual graft volume that is usually encountered. Administration of glypressin with or without splenectomy is effective in the management of patients with SFSS. Decreasing BMI of the recipient plays a role in decreasing the incidence of SFSS and its manifestations.