Liver volume in the cirrhotic patient: does size matter?

Abstract

Background: While it is established that cirrhosis results in a decrease in liver volume (LV), whether LV itself predicts patient survival is unknown. We hypothesize that estimated LV is an important prognostic indicator in patients with cirrhosis.

Methods: Data was gathered retrospectively from consecutive patients evaluated for a liver transplant from January 2001 to June 2006. Of 500 patients identified, 323 patients met both inclusion and exclusion criteria. LV per ideal body weight (IBW) was used to correct for body size, and LV/IBW was stratified by median split for survival analyses. Patients were classified into one of three clinical groups: hepatocellular disease (n = 229), cholestatic disease (n = 56), and miscellaneous (n = 38). One of three possible clinical outcomes (survival, liver transplantation, or death) was recorded during the 5-year follow-up, the latter two grouped together as "transplant/death."

Results: Transplant/death occurred in 283 (88 %) subjects. Overall, there was a significant increase in transplant/death in those with lower LV/IBW (χ(2) = 5.27, p = 0.022). When considering the subset with hepatocellular disease, lower LV/IBW was a robust predictor of transplant/death (χ(2) = 9.62, p = 0.002). In multivariate analyses, the LV/IBW trended toward predicting transplant/death (ExpB = 0.943, p = 0.053) independent of Model for End stage Liver Disease (MELD) (ExpB = 1.13, p = 0.001).

Discussion: LV has important predictive value in patients with cirrhosis from hepatocellular disease. This observation appears to be independent of MELD, suggesting LV may impart important prognostic information that is not captured by the MELD score alone. Thus, LV may serve as an important adjunct to the MELD score in patients with hepatocellular disease.

Fig. 1

Survival over time in all patients with end stage liver disease (ESLD). There was a survival advantage for the large LV/IBW group in all 323 patients with ESLD (X² = 5.27, p = 0.022)

Fig. 2

Survival over time in end stage liver disease (ESLD) patients with hepatocellular disease. There was a distinct survival advantage for the large LV/IBW group in group 1—patients with hepatocellular injury (X² = 9.62, p = 0.002)

Fig. 3

Survival over time in end stage liver disease (ESLD) patients with cholestasis. There was a trend favoring a survival advantage for the small LV/IBW group in group 2—patients with cholestasis—which was not statistically significant (X² = 1.74, p = 0.18). This is opposite from the trend we saw for group 1

Fig. 4

Survival over time in end stage liver disease (ESLD) patients with miscellaneous causes. There may have been a slight trend favoring a survival advantage for the large LV/IBW group in group 3—patients with miscellaneous causes of ESLD; however this was not statistically significant (X² = 0.479, p = 0.48)

Fig. 5

Transplant/death rate over time for all end stage liver disease (ESLD) patients. When looking at all 323 patients in the study, the transplant/death rate was higher in the small LV/IBW at 3, 6 months, and 1 year. This difference in transplant/death rate reached statistical significance at 1 year, with a 64 % transplant/death rate in the small LV/IBW group compared to a 51 % transplant/death rate in the large LV/IBW group (p = 0.021)

Fig. 6

Transplant/death rate over time for end stage liver disease (ESLD) patients with hepatocellular disease. When looking at group 1—the patients with hepatocellular injury—again there was a higher transplant/death rate at all three time points. The difference in transplant/death rate reached statistical significance by the 6-month time period, and at 1 year there was a 68 % transplant/death rate in the small LV/IBW group compared to a 51 % transplant/death rate in the large LV/IBW group (p = 0.009)