Background : Evaluating hepatic steatosis is key in selecting living liver donors, while focusing on non-invasive methods like CT scans due to the risks and drawbacks of liver biopsies. We compared the prognostic value of the Liver/Spleen (L/S) ratio from CT images with the graft-to-recipient weight ratio (GRWR) in predicting transplant outcomes.

Methods : Involving 196 participants from living donor LT cases, we analyzed donors' preoperative L/S ratios from CT scans and recipients' GRWR. Data included demographics, transplant details, and postoperative outcomes. Statistical methods like the Pearson chi-square and Mann-Whitney U tests evaluated the impact of GRWR and L/S ratios on complications like small for size syndrome, organ rejection, and survival.

Results : Findings showed an average age of 42.23 years for recipients and 34.36 years for donors. Average MELD score was 21.59, while pediatric patients had an average PELD of 19.09 Graft loss was significantly associated with lower graft volumes (average 790 grams), and regression analysis indicated that patient and donor ages influenced GRWR. Lower graft volumes were also noted in retransplantation cases. While the L/S ratio wasn't significant in graft loss, lower GRWR values correlated with biopsy-confirmed rejection. Patients with rejection had lower L/S ratios, highlighting potential roles of these measures in outcome prediction.

Conclusions : Low GRWR scores correlate with increased risks of organ complications, but optimal GRWR threshold is unclear, highlighting the importance of additional factors like the L/S ratio. Future research should examine the effects of non-invasive liver tests for hepatosteatosis and the incorporation of GRWR and L/S ratios in predicting transplant outcomes.