Abstract
P1322
Introduction: Currently, post hepatectomy liver failure (PHLF) in donors and early allograft dysfunction (EAD) or Small for Size Syndrome (SFSS) in recipients after living donor liver transplantation (LDLT) is predicted by CT volumetry-based future liver remnant (FLR) volume and graft-recipient weight ratio (GRWR). However, CT does not assess the functional capacity of the liver and hence the graft size. 99mTc-Mebrofenin hepatobiliary scintigraphy (HBS) can benefit in this regard.
Methods: Total liver function (TLF) on HBS calculated as mebrofenin uptake rate (MUR) performed initially in healthy volunteers (Group A, n=30), patients with liver steatosis 10-20%, fibrosis F2-F4, resolving cholestasis (Group B, n=49) and compensated cirrhosis (Group C, n=18). Later, HBS added to the liver donor evaluation protocol (n=70) to calculate TLF-MUR and regional functions, which are FLR-cMUR and Graft-MUR/Recipient-BSA (functional graft size). The endpoints were PHLF in right-lobe donors and EAD/SFSS in all recipients after LDLT.
Results: TLF-MUR (%/min) and TLF-cMUR (%/min/sqmt) of Groups A ,B,C are (Mean±SD) 15.6±2.2, 12.1±2.0, 7.6±2.9 and 9.3±1.7, 7.23 ±1.4, 4.4±1.9 respectively (p-0.001) (Figure) Five out of 61 right-lobe donors had grade I PHLF. Predictors of PHLF were male donors (p-0.007), TLF-cMUR (p-0.013), and FLR-cMUR (p-0.029). FLR% on CT (p-0.927), donor age (p-0.794), and liver histology (p-0.486) were not predicting PHLF. On Receiver-operating characteristic curves (ROC), the area under the curve (AUC) of TLF-cMUR was 0.925, and FLR-cMUR was 0.873 (Table). Out of 70 recipients, ten had either EAD or SFSS after LDLT. Predictors of EAD/SFSS were TLF-MUR (p-0.002) and Graft-MUR/R-BSA (p-0.002). Na MELD (p-0.839), GRWR% (p-0.098), Graft weight (p-0.117), and Graft Spleen ratio (p-0.590) were not predicting EAD/SFSS. On ROC, the AUC of TLF-MUR was 0.820, and Graft MUR/BSA (R) was 0.864. One recipient had mortality in non-EAD/SFSS group, the probable cause of death was steroid-resistant acute cellular rejection or severe sepsis. Donor HBS parameters were TLF-MUR 14.7 %/min and Graft-MUR/R-BSA 5.06 %/min/sqmt -R, and GRWR 0.89.
Conclusions: MUR calculated on donor HBS precisely predicts the incidence of PHLF and EAD/SFSS. Non-invasive HBS in donor evaluation protocol maximizes donor safety and recipient outcomes fulfilling unmet needs. Objectively measured liver functional capacity can define adequate functional graft size.
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