Complete surgical resection is the treatment of choice for patients with liver metastases, but in some patients, it is not possible to obtain a complete R0 resection. Moreover, the recurrence rate is up to 75% after three years. After the experience of the Oslo group with cadaveric liver transplant, some centers are starting their experience with liver transplant for colorectal liver metastasis.
To present our initial experience with living donor liver transplant for colorectal liver metastasis.
From 2019 to 2022, four liver transplants were performed in patients with colorectal liver metastases according to the Oslo criteria.
Four patients underwent living donor liver transplants, male/female ratio was 3:1, mean age 52.5 (42–68 years). All patients were included in Oslo criteria for liver transplant. Two patients had already been submitted to liver resection. The decision for liver transplant occurred after discussion with a multidisciplinary team. Three patients recurred after the procedure and the patient number 3 died after chemotherapy.
Living donor liver transplant is a viable treatment option for colorectal liver metastasis in Brazil, due to a shortage of donors.
Computed tomography volumetry (CTV) is a useful tool for predicting graft weights (GW) for living donor liver transplantation (LDLT). Few studies have examined the correlation between CTV and GW in normal liver parenchyma.
To analyze the correlation between CTV and GW in an adult LDLT population and provide a systematic review of the existing mathematical models to calculate partial liver graft weight.
Between January 2009 and January 2013, 28 consecutive donors undergoing right hepatectomy for LDLT were retrospectively reviewed. All grafts were perfused with HTK solution. Estimated graft volume was estimated by CTV and these values were compared to the actual graft weight, which was measured after liver harvesting and perfusion.
Median actual GW was 782.5 g, averaged 791.43±136 g and ranged from 520-1185 g. Median estimated graft volume was 927.5 ml, averaged 944.86±200.74 ml and ranged from 600-1477 ml. Linear regression of estimated graft volume and actual GW was significantly linear (GW=0.82 estimated graft volume, r2=0.98, slope=0.47, standard deviation of 0.024 and p<0.0001). Spearman Linear correlation was 0.65 with 95% CI of 0.45 - 0.99 (p<0.0001).
The one-to-one rule did not applied in patients with normal liver parenchyma. A better estimation of graft weight could be reached by multiplying estimated graft volume by 0.82.
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