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Risks of Living Donor Liver Transplantation Using Small-For-Size Grafts.

Abstract：

BACKGROUND:In living donor liver transplantation (LDLT), a graft-to-recipient weight ratio (GRWR) of under 0.8 is recognized as the critical graft size. Our aim was to compare the survival rates of recipients with small-for-size grafts (SFSG: GRWR <0.8), normal-sized grafts (NSG), and large-for-size grafts (LFSG: GRWR ≥ 3.5) and to investigate the mortality risk with SFSG. METHODS:Between 1991 and April 2019, we performed 188 LDLT surgeries. Recently, we added splenectomy when portal vein pressure is high (>17 mm Hg) to interrupt the splenic bloodstream. We divided all LDLT cases retrospectively into 3 groups: an SFSG group (n = 22), NSG group (n = 154), and LFSG group (n = 12). We investigated the survival rates in these groups. Furthermore, we divided the SFSG group into 2 subgroups: an SFSG with splenectomy (SFSG+S) group (n = 7) and an SFSG without splenectomy group. We investigated the occurrence rates of lethal complications such as portal vein thrombosis, hepatic artery thrombosis, and hepatic vein thrombosis. RESULTS:The 5-year survival rate in the SFSG group was significantly lower (52.8%) than in the other groups (NSG: 84.5%; LFSG: 83.3%), but that of the SFSG+S group was similar (80.0%) to that of other groups. There was no difference in the occurrence of postoperative complications such as portal vein thrombosis, hepatic artery thrombosis, or hepatic vein thrombosis between the SFSG+S group and other groups. CONCLUSIONS:Graft survival of LDLT using SFSG+S was as good as that of normal-sized grafts. Reducing portal vein pressure was important for SFSG.

journal_name

Transplant Proc

journal_title

Transplantation proceedings

authors

Miyagi S,Shono Y,Tokodai K,Nakanishi W,Nishimura R,Fujio A,Sasaki K,Miyazaki Y,Kakizaki Y,Sasajima H,Kamei T,Unno M

doi

10.1016/j.transproceed.2020.01.136

subject

Has Abstract

pub_date

2020-01-01 00:00:00

pages

1825-1828

issue

6

eissn

0041-1345

issn

1873-2623

pii

S0041-1345(19)31514-3

journal_volume

52

pub_type

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