Body Surface Area Can Determine Success of Liver Transplantation

A new study determines the safe range of deceased liver transplantation graft-size mismatch using body surface area index (BSAi).

Researchers at the University of Miami (FL, USA) and the University of Tokyo (Japan) conducted a study involving 24,509 patients to develop a multivariate survival model that can be used to estimate the hazard risk of BSAi for three-year graft survival, using data derived from the US national registry database between 2005 and 2010. BSAi was calculated by dividing the BSA of the donor with the BSA of recipient.

The results showed that small-for-size grafts (BSAi less than 0.78) had a significant impact on graft dysfunction, with progressive increase of hazard risk towards the lowest end and a higher incidence of primary graft nonfunction and vascular thrombosis. On the other hand, large-for-size grafts (BSAi greater than 1.24) had a significant impact on graft dysfunction with progressive increase of hazard risk towards the largest end. The study was published ahead of print on April 10, 2013, in Transplant International.

“In live donor liver transplantation, rigorous standardized criteria for matching of liver volume between donor and recipient have prevented graft loss due to size mismatch,” concluded lead author Kyota Fukazawa, MD, and colleagues of the division of solid organ transplantation. “Therefore, BSAi higher than 0.78 and lower than 1.24 appears to be a safe range to avoid adverse outcome associated with size mismatch in deceased liver transplantation.”

In physiology and medicine, BSA is the measured or calculated surface of a human body. For many clinical purposes, BSA is a better indicator of metabolic mass than body weight because it is less affected by abnormal adipose mass. Examples of uses of BSA include renal clearance, usually divided by the BSA to gain an appreciation of the true required glomerular filtration rate (GFR); chemotherapy, often dosed according to the patient's BSA; and glucocorticoid dosing, expressed in terms of BSA for calculating maintenance doses.

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