Prospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2021; 27(39): 6701-6714
Published online Oct 21, 2021. doi: 10.3748/wjg.v27.i39.6701
Standard liver weight model in adult deceased donors with fatty liver: A prospective cohort study
Bo Li, Pan-Yu Chen, Yi-Fei Tan, He Huang, Min Jiang, Zhen-Ru Wu, Chen-Hao Jiang, Dao-Feng Zheng, Diao He, Yu-Jun Shi, Yan Luo, Jia-Yin Yang
Bo Li, Yi-Fei Tan, Chen-Hao Jiang, Dao-Feng Zheng, Diao He, Jia-Yin Yang, Department of Liver Surgery, Liver Transplantation Centre, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Bo Li, Yi-Fei Tan, Chen-Hao Jiang, Dao-Feng Zheng, Diao He, Jia-Yin Yang, Laboratory of Liver Transplantation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Pan-Yu Chen, Operating Room, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
He Huang, Yan Luo, Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Min Jiang, Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Zhen-Ru Wu, Yu-Jun Shi, Laboratory of Pathology, Key Laboratory of Transplant Immunology and Engineering, National Health Commission, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Li B and Chen PY contributed equally to this work; Li B collected all the clinical data, analyzed the data, drafted the manuscript and prepared the revised materials; Chen PY collected the data of donor liver weight in the operating room and assisted with data analysis; Tan YF analyzed the data, drafted the manuscript and prepared the revised materials; Huang H and Luo Y assisted with ultrasound examination and data processing; Wu ZR and Shi YJ helped with tissue staining and histological assessment; Zheng DF, He D and Jiang CH assisted with donor liver weight measurement and tissue Sampling; Jiang M participated in design of the study, data processing and data analysis; Yang JY participated in design and oversight of the study and was involved with drafting of the manuscript; all authors have read and approve the final manuscript.
Supported by New Clinical Technology Project, West China Hospital, Sichuan University, No. 20HXJS012; and National Natural Science Foundation of China, No. 81770653 and No. 82070674.
Institutional review board statement: This study was reviewed and approved by the West China Hospital of Sichuan University Institutional Review Board.
Clinical trial registration statement: This study was registered at http://www.chictr.org.cn. The registration identification number is ChiCTR2000041406.
Informed consent statement: All study participants, or their legal guardians, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jia-Yin Yang, MD, PhD, Chief Doctor, Director, Professor, Surgeon, Department of Liver Surgery, Liver Transplantation Centre, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China. doctoryjy@scu.edu.cn
Received: June 20, 2021
Peer-review started: June 20, 2021
First decision: August 8, 2021
Revised: August 22, 2021
Accepted: September 16, 2021
Article in press: September 16, 2021
Published online: October 21, 2021
Processing time: 121 Days and 16.9 Hours
Abstract
BACKGROUND

Standard liver weight (SLW) is frequently used in deceased donor liver transplantation to avoid size mismatches with the recipient. However, some deceased donors (DDs) have fatty liver (FL). A few studies have reported that FL could impact liver size. To the best of our knowledge, there are no relevant SLW models for predicting liver size.

AIM

To demonstrate the relationship between FL and total liver weight (TLW) in detail and present a related SLW formula.

METHODS

We prospectively enrolled 212 adult DDs from West China Hospital of Sichuan University from June 2019 to February 2021, recorded their basic information, such as sex, age, body height (BH) and body weight (BW), and performed abdominal ultrasound (US) and pathological biopsy (PB). The chi-square test and kappa consistency score were used to assess the consistency in terms of FL diagnosed by US relative to PB. Simple linear regression analysis was used to explore the variables related to TLW. Multiple linear regression analysis was used to formulate SLW models, and the root mean standard error and interclass correlation coefficient were used to test the fitting efficiency and accuracy of the model, respectively. Furthermore, the optimal formula was compared with previous formulas.

RESULTS

Approximately 28.8% of DDs had FL. US had a high diagnostic ability (sensitivity and specificity were 86.2% and 92.9%, respectively; kappa value was 0.70, P < 0.001) for livers with more than a 5% fatty change. Simple linear regression analysis showed that sex (R2, 0.226; P < 0.001), BH (R2, 0.241; P < 0.001), BW (R2, 0.441; P < 0.001), BMI (R2, 0.224; P < 0.001), BSA (R2, 0.454; P < 0.001) and FL (R2, 0.130; P < 0.001) significantly impacted TLW. In addition, multiple linear regression analysis showed that there was no significant difference in liver weight between the DDs with no steatosis and those with steatosis within 5%. Furthermore, in the context of hepatic steatosis, TLW increased positively (non-linear); compared with the TLW of the non-FL group, the TLW of the groups with hepatic steatosis within 5%, between 5% and 20% and more than 20% increased by 0 g, 90 g, and 340 g, respectively. A novel formula, namely, -348.6 + (110.7 x Sex [0 = Female, 1 = Male]) + 958.0 x BSA + (179.8 x FLUS [0 = No, 1 = Yes]), where FL was diagnosed by US, was more convenient and accurate than any other formula for predicting SLW.

CONCLUSION

FL is positively correlated with TLW. The novel formula deduced using sex, BSA and FLUS is the optimal formula for predicting SLW in adult DDs.

Keywords: Standard liver weight; Body surface area; Fatty liver; Sex; Deceased donors

Core Tip: This study was the first to explore the relationship between fatty liver (FL) and total liver weight (TLW) in detail using pathological biopsy based on adult deceased donors (DDs) and developed a new standard liver weight (SLW) formula. Moreover, to conveniently apply the SLW formula to the clinic, we introduced ultrasound (US). Notably, we found that FL was positively correlated with TLW and that US had a high diagnostic ability for mild to severe FL, which could increase liver weight significantly. The formula deduced using sex, BSA and FLUS is the optimal formula for predicting SLW in adult DDs.