PMC10404149_01
PMC10404149_02
(a) LAI +16 on plain CT scan. (b) MR fat fraction 2-3% in both lobes (LAI = liver attenuation index).
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The computed tomography (CT) estimation calculated liver attenuation of 66.4 Hounsfield units (HU) (right lobe 66.1 and left lobe 66.7) and a mean splenic attenuation of 49.6 HU, giving us an LAI of +16.5 and +17.1 for the right and left hepatic lobes, respectively (Figure 1(a)). We routinely perform magnetic resonance cholangiopancreatography (MRCP) in all donors, and we also ran MR fat estimation on her which revealed a fat content of approximately 3% in both the right and left liver lobes (Figure 1(b)).
Visceral fat to subcutaneous fat (V/S) ratio <0.4 indicating subcutaneous obesity and not visceral obesity. VFA: visceral fat area; SFA: subcutaneous fat area; V/S: VFA/SFA ratio taken at L4-level.
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V/S ratio, which is a ratio of visceral fat area to the subcutaneous fat, was 0.37 (<0.4 refers to subcutaneous obesity as compared to >0.4 in visceral obesity) (Figure 2). Volumetric analysis was then performed which is outlined in Table 1 (Table 1).
(a) The difference between visceral fat and abdominal wall fat in donor, indicating subcutaneous fat obesity. (b) After reperfusion in recipient, showing a healthy soft pink liver.
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In the operating room, the donor liver looked healthy and nonsteatotic (Figure 3(a)). After completing arterial and biliary reconstructions, ultrasound (USG) Doppler showed excellent flows and the graft was pink and soft on inspection (Figure 3(b)).