Abstract

Background: Accurate preoperative estimation of graft weight is essential to ensure safety in living donor liver transplantation. This study aimed to evaluate the accuracy of computed tomography (CT) in estimating right liver graft weight.

Methods: A retrospective descriptive study was conducted on 57 living donors who underwent right liver graft procurement at the University Medical Center Ho Chi Minh City between June 2018 and December 2025. Estimated graft volume (EGV) based on CT volumetry was compared with the actual graft weight (AGW). Correlation was assessed using Pearson’s correlation coefficient, and agreement was analyzed using Bland–Altman analysis. A correction factor was determined based on the AGW/EGV ratio.

Results: EGV showed a strong correlation with AGW (r = 0.9; p < 0.001) but tended to overestimate the actual graft weight by approximately 19% (AGW/EGV = 0.81 ± 0.04). Bland–Altman analysis demonstrated a mean difference of 157.8 g (limits of agreement: -39.2 g to 276.3 g). The discrepancy increased with graft size (R² = 0.261). After applying a correction factor of 0.81, the proportion of cases with an estimation error >10% decreased from 100% to 19.2%, and the rate of GRWR misclassification decreased from 12.3% to 0%. The mean difference after correction was -52.5 g (limits of agreement: -141.0 g to 36.1 g).

Conclusions: CT-based estimation of right liver graft volume shows good correlation with actual graft weight but demonstrates a systematic bias. Applying a correction factor of 0.81 significantly improves the accuracy of graft weight estimation and GRWR assessment, thereby enhancing safety in living donor liver transplantation.