Critical graft size and functional recovery in living donor liver transplantation

Chui, A.K.K; Rao, A.R.; Island, Eddie; Lau, Wan Yee

doi:10.1016/j.transproceed.2004.08.036

Cited by 27 publications

(23 citation statements)

References 6 publications

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“…In addition, the need for high levels of antigen in largefor-size grafts is associated with a high incidence of rejection. 4,6 Consistent with these findings, in our study, intraoperative hypotension was observed more frequently in patients with a G/R > 4%. Because the large graft receives relatively low portal blood flow due to the small recipient size, impairment in hepatic microcirculation may occur.…”

Section: Discussionsupporting

confidence: 90%

“…With a large-for-size graft, there is low portal blood flow, which impairs hepatic circulation, as well as size discordance between the vascular lumens, insufficient blood supply to the graft, and the insufficient size of the recipient's abdominal cavity. [5][6][7][8] Akdur and colleagues showed that large-for-size grafts may cause abdo1minal compartment syndrome and vascular problems as a result of the relatively small recipient size. 2 We conducted this study to raise awareness of the metabolic and hemodynamic changes associated with graft-recipient size mismatching.…”

Section: Introductionmentioning

confidence: 99%

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Ersoy

Kaplan²,

Özdemirkan³

et al. 2017

Exp Clin Transplant

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Objectives: To analyze how graft-weight-to-bodyweight ratio in pediatric liver transplant affects intraoperative and early postoperative hemodynamic and metabolic parameters. Materials and Methods: We reviewed data from 130 children who underwent liver transplant between 2005 and 2015. Recipients were divided into 2 groups: those with a graft weight to body weight ratio > 4% (large for size) and those with a ratio ≤ 4% (normal for size). Data included demographics, preoperative laboratory findings, intraoperative metabolic and hemodynamic parameters, and intensive care followup parameters. Results: Patients in the large-graft-for-size group (> 4%) received more colloid solution (57.7 ± 20.1 mL/kg vs 45.1 ± 21.9 mL/kg; P = .08) and higher doses of furosemide (0.7 ± 0.6 mg/kg vs 0.4 ± 0.7 mg/kg; P = .018). They had lower mean pH (7.1 ± 0.1 vs 7.2 ± 0.1; P = .004) and PO2 (115.4 ± 44.6 mm Hg vs 147.6 ± 49.3 mm Hg; P = .004) values, higher blood glucose values (352.8 ± 96.9 mg/dL vs 262.8 ± 88.2 mg/dL; P < .001), and lower mean body temperature (34.8 ± 0.7°C vs 35.2 ± 0.6°C; P = .016) during the neohepatic phase. They received more blood transfusions during both the anhepatic (30.3 ± 24.3 mL/kg vs 18.8 ± 21.8 mL/kg; P = .013) and neohepatic (17.7 ± 20.4 mL/kg vs 10.3 ± 15.5 mL/kg; P = .031) phases and more fresh frozen plasma (13.6 ± 17.6 mL/kg vs 6.2 ± 10.2 mL/kg; P = .012) during the neohepatic phase. They also were more likely to be hypotensive (P < .05) and to receive norepinephrine infusion more often (44% vs 22%; P < .05) intraoperatively. More patients in this group were mechanically ventilated in the intensive care unit (56% vs 31%; P = .035). There were no significant differences between the groups in postoperative acute renal dysfunction, graft rejection or loss, infections, length of intensive care stay, and mortality (P > .05). Conclusions: High graft weight-to-body-weight ratio is associated with adverse metabolic and hemodynamic changes during the intraoperative and early postoperative periods. These results emphasize the importance of using an appropriately sized graft in liver transplant.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Untitled

Ersoy

Kaplan²,

Özdemirkan³

et al. 2017

Exp Clin Transplant

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show abstract

“…There is no doubt that the incidence of SFSS is higher when smaller grafts with GRWR < 0.8% is used. 5,7 Inadequate hepatic venous outflow of partial grafts can lead to a situation similar to SFSS but this is a problem more often seen in right-lobe grafts. In any case, outflow obstruction is a technical problem and all such surgical issues need to be excluded before the diagnosis of SFSS can be made.…”

Section: Ways To Avoid Small For Size Syndromementioning

confidence: 99%

“…6 Application of LDLT for larger adolescents and adults led to unearthing of the 'small for size syndrome' (SFSS), which merely denoted early liver dysfunction due to inadequate hepatocyte mass. 5,7 Small for size syndrome, hitherto unheard of, in whole liver transplants referred to the constellation of persistent ascites, cholestasis, coagulopathy, and encephalopathy in the setting of a partial liver graft with GRWR < 0.8% without a technical cause. Small for size syndrome resulted in higher incidence of septic complications and increased mortality.…”

mentioning

confidence: 99%

“…By and large, it is agreed that SFSS can be avoided if GRWR is greater than 1%, and there is an increased frequency of SFSS when GRWR is < 0.8%. 5,7,8 So, the obvious way to avoid SFSS would be to use right-lobe grafts that would increase GRWR but on the other hand create a higher risk to the donor, a contradictory setting! This review focuses on the pros and cons of left-lobe grafts and ways to ameliorate SFSS when used for adult LDLT.…”

mentioning

confidence: 99%

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