Accuracy and Efficiency of Right-Lobe Graft Weight Estimation Using Deep-Learning-Assisted CT Volumetry for Living-Donor Liver Transplantation.

Rohee Park,Yusub Sung,Sanghyun Choi,Seungsoo Lee,Heung-Il Suk,Jeeseok Yoon,Hyoungjung Kim

doi:10.3390/diagnostics12030590

Abstract

CT volumetry (CTV) has been widely used for pre-operative graft weight (GW) estimation in living-donor liver transplantation (LDLT), and the use of a deep-learning algorithm (DLA) may further improve its efficiency. However, its accuracy has not been well determined. To evaluate the efficiency and accuracy of DLA-assisted CTV in GW estimation, we performed a retrospective study including 581 consecutive LDLT donors who donated a right-lobe graft. Right-lobe graft volume (GV) was measured on CT using the software implemented with the DLA for automated liver segmentation. In the development group (n = 207), a volume-to-weight conversion formula was constructed by linear regression analysis between the CTV-measured GV and the intraoperative GW. In the validation group (n = 374), the agreement between the estimated and measured GWs was assessed using the Bland–Altman 95% limit-of-agreement (LOA). The mean process time for GV measurement was 1.8 ± 0.6 min (range, 1.3–8.0 min). In the validation group, the GW was estimated using the volume-to-weight conversion formula (estimated GW [g] = 206.3 + 0.653 × CTV-measured GV [mL]), and the Bland–Altman 95% LOA between the estimated and measured GWs was −1.7% ± 17.1%. The DLA-assisted CT volumetry allows for time-efficient and accurate estimation of GW in LDLT.

Highlights

Living-donor liver transplantation (LDLT) is an effective therapeutic option for patients with end-stage liver disease [1]
CT volumetry has been widely used for preoperative graft volume measurement in LDLT [4,5,6,7,8,9,10,11,12]
The volume-to-weight conversion formulae used in the previous studies were not reliable since they were derived from small study populations (i.e., ≤16 subjects) [10,11,14], pathologic liver conditions [10], or the assumption that the liver and water have the same density [12,13,15], which may have led to biased estimations of graft weight

Summary

Introduction

Living-donor liver transplantation (LDLT) is an effective therapeutic option for patients with end-stage liver disease [1]. The accurate preoperative estimation of graft weight is a prerequisite step in LDLT to ensure the safety of both recipients and donors. CT volumetry has been widely used for preoperative graft volume measurement in LDLT [4,5,6,7,8,9,10,11,12]. The volume-to-weight conversion formulae used in the previous studies were not reliable since they were derived from small study populations (i.e., ≤16 subjects) [10,11,14], pathologic liver conditions [10], or the assumption that the liver and water have the same density [12,13,15], which may have led to biased estimations of graft weight. Previous studies assessed the correlations or mean differences between the estimated and actual graft weights, but did not evaluate the measurement error of CT volumetric graft weight estimation [5,6,7,8,9,10,11,12], which is important to predict the range of actual graft weight in individual LDLT donors

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