Anatomical Size Disparities in Liver Transplantation: Imaging-Derived Abdominal Dimensions and Their Association With Waitlist Outcomes

IF 1.8 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2026-08-05 DOI:10.1111/ctr.70634

Rafal Mazur, Alyssa Stetson, Alissa Cutrone, David Cron, Joel Adler, Shimul Shah, Heidi Yeh

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Abstract

Background

The objective of this study is to evaluate the association between two imaging-derived measures—anteroposterior diameter (APD) and lateral abdominal wall–IVC distance (L-IVC)—and liver transplant (LT) waitlist outcomes.

Methods

Retrospective cohort study of 520 adult LT candidates listed at a single academic transplant center from January 1, 2015, to December 31, 2023. APD and L-IVC were measured using cross-sectional abdominal imaging and categorized into three groups using interquartile thresholds: APD (<15.0 cm, 15.0–20.0 cm, >20.0 cm) and L-IVC (<10.0 cm, 10.0–12.5 cm, ≥12.5 cm). The primary outcome was time to LT; the competing outcome was waitlist removal due to death or clinical deterioration. Sub-distribution hazard ratios (SHRs) were estimated using competing risks regression. Harrell's C-statistic and bootstrap comparisons were used to evaluate discrimination versus height, BMI, and body surface area (BSA).

Results

Among 520 candidates (mean [SD] age, 55.7 [10.9] years; 37.5% women), small APD (SHR = 0.51; CI: 0.33–0.72; p = 0.02) and L-IVC (SHR = 0.39; CI: 0.21–0.62: p < 0.001) were associated with lower transplant probability. Candidates with larger APD (>20.0 cm) had the highest risk of waitlist removal (SHR = 1.47; CI:1.02–1.87; p = 0.04). L-IVC was most strongly associated with LT (C-statistic = 0.65) and waitlist removal (C-statistic = 0.67). In sex-stratified models, men with small APD or L-IVC had significantly lower transplant probability, while women with mid-range APD (15.0–20.0 cm) or L-IVC ≥ 12.5 cm had the highest transplant likelihood.

Conclusion

Anatomical measurements derived from imaging are more strongly associated with liver transplant waitlist outcomes, outperforming height, BMI, and BSA.

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肝移植的解剖尺寸差异：影像学得出的腹部尺寸及其与候补结果的关系。

背景：本研究的目的是评估两种影像学指标——前后壁直径（APD）和侧腹壁- ivc距离（L-IVC）与肝移植（LT）等待名单结果之间的关系。方法：对2015年1月1日至2023年12月31日在某学术移植中心登记的520例成人肝移植患者进行回顾性队列研究。采用横断面腹部成像测量APD和L-IVC，并使用四分位数阈值将其分为三组：APD （20.0 cm）和L-IVC(结果：在520名候选人中（平均[SD]年龄55.7[10.9]岁；37.5%为女性），较小的APD （SHR = 0.51; CI: 0.33-0.72; p = 0.02）和L-IVC （SHR = 0.39; CI: 0.21-0.62: p < 0.001）与较低的移植概率相关。APD较大（>20.0 cm）的候选人被排除候补名单的风险最高（SHR = 1.47; CI:1.02-1.87; p = 0.04）。L-IVC与LT （C-statistic = 0.65）和候补名单移除（C-statistic = 0.67）相关性最强。在性别分层模型中，小APD或L-IVC的男性移植可能性显著降低，而中APD （15.0-20.0 cm）或L-IVC≥12.5 cm的女性移植可能性最高。结论：来自影像学的解剖测量与肝移植候补结果的相关性更强，优于身高、BMI和BSA。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.