RESUMO
Background: An accurate preoperative estimate of the graft weight and remnant liver volume is vital to avoid small-for-size syndrome[SFSS] in the recipient and ensure donor safety after Living donor liver transplantation [LDLT]. CT has been widely used as a method for the preoperative volumetric assessment of the liver transplantation. The graft size as measured from preoperative imaging which is often different from the actual weight of the liver graft as obtained by the donor hepatectomy. The difference between preoperative volumetry and Actual graft weight [AGW] was graded into minimal difference [15%]
Aim of the Work: This study was conducted to assess different preoperative factors that might affect the difference between estimated graft weight and actual graft weight in liver transplantation
Patients and Methods: This single center retrospective study was conducted on 86 cases who have been subjected to donation for liver transplantation in Ain Shams Center of organ transplantation. Donors were divided into two groups: Group [A]: formed of 33 donors who showed minimal difference [15%] between EGV and AGW. Each donor data was examined for: Age, Sex: male or female, Body mass index [BMI], Lipid profile [positive / negative] Type of hepatectomy [Rt lobe / Lt lobe], AGW.Estimated graft weight [EGW], Total liver volume, Liver biopsy: Fibrosis [positive/ negative], Steatosis: Negative: [0%] and Positive: [5% or 10%]
Results: EGW of 903 gm was identified as cutoff point of the best specificity with the best sensitivity showing 60.4% and 60.6% for sensitivity and specificity, respectively. At this cutoff point, 47.7% of cases [n=41] showed EGW < 903 gm, while 52.3% of cases [n=45] showed EGW >/= 903 gm. Thus, it can be said that cases showed EGW >/= 903 gm have a probability of 71.1% to have big difference between EGW and AGW [>/=15%]. EGW of 1069 gm was identified as another cutoff point of a better specificity on ROC curve showing 32.1% and 93.9% for sensitivity and specificity, respectively, on ROC curve. At this cutoff point, 77.9% of cases [n=67] showed EGW < 1069 gm, while 22.1% of cases [n=19] showed EGW >/= 1069 gm. Thus, it can be said that cases showed EGW >/=1069 gm have a probability of 89.5% to have big difference between EGW and AGW [>/=15%]. TLW of 1587 gm was identified as cutoff point of the best specificity with the best sensitivity and specificity on ROC curve showing 56.6% and 60.6% for sensitivity and specificity, respectively, on ROC curve. At this cutoff point, 50% of cases [n=43] showed TLW < 1587 gm, while 50% of cases [n=43] showed TLW >/= 1587 gm. Thus, it can be said that cases showed TLW >/=1587 gm have a probability of 69.8% to have big difference between EGW and AGW [>/=15%]. TLW of 1807 gm was identified as another cutoff point of better specificity on ROC curve showing 18.9% and 93.9% for sensitivity and specificity, respectively, on ROC curve. At this cutoff point, 86% of cases [n=74] showed TLW < 1807 gm, while 14% of cases [n=12] showed TLW >/= 1807 gm. Thus, it can be said that cases showed TLW >/=1807 gm have a probability of 83.3% to have big difference between EGW and AGW [>/=15%]
Conclusion: TLV and EGV in CT volumetry are most reliable preoperative factors that can predict big difference between EGW and AGW. Re-evaluation of CT volumetry protocol is recommended for better prediction
RESUMO
Background: liver transplantation surgically replaces a failing or diseased liver with one that is normal and healthy. At this time, transplantation is the only cure for liver insufficiency or liver failure because no device or machine reliably performs all of the functions of the liver
Aim of the Work: this study aimed to highlight risk factors of the venous thromboembolism in donors of living donor liver transplant and its management
Patients and Methods: this study included 40 patients who underwent hepatectomy for living donor liver transplant. All patients were evaluated extensively, including history and physical examination and specialty consultations when indicated. All patients did haematological studies to detect the risk factors of thromboembolic disease
Results: in patients with manifestations of venous thromboembolism 2 donors have single risk factor for venous thromboembolism and 4 donors have double risk factors
Conclusion: presence of multiple risk factors for venous thromboembolism led to increase in its incidence, so during preoperative assessment of the donors, if they have multiple risk factors for thrombosis some precautions should be taken to avoid venous thrombosis
Recommendations: preoperative precautions include heamatological consultations for the donors and prophylaxis dose of anticoagulant. Intra operative precautions included pneumatic calf pressure, elastic stocking. Finally postoperative precautions should be continued, these donors should take therapeutic doses of anticoagulants and follow up by lower limb venous duplex