Graft selection strategy in adult‐to‐adult living donor liver transplantation: When both hemiliver grafts meet volumetric criteria

Kurihara, Toshio; Yoshizumi, Tomoharu; Yoshida, Yasuhiko; Ikegami, Toru; Itoh, Shinji; Harimoto, Norifumi; Ninomiya, Mizuki; Uchiyama, Hideaki; Okabe, Hidetoshi; Kimura, Koichi; Kawanaka, Hirofumi; Shirabe, Ken; Maehara, Yoshihiko

doi:10.1002/lt.24431

Cited by 22 publications

(14 citation statements)

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“…If the prognosis for a patient is poorer because of a high MELD score or an old donor age, using the larger RL would improve the transplant outcome[19]. In the current study, all the grafts were small for size, and LL-LDLT and RL-LDLT had little difference when long-term patient survival is concerned.…”

Section: Discussionmentioning

confidence: 73%

Outcomes of right-lobe and left-lobe living-donor liver transplantations using small-for-size grafts

She¹,

Chok²,

Chan³

et al. 2017

WJG

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AIMTo analyze the outcomes of living-donor liver transplantation (LDLT) using left-lobe (LL) or right-lobe (RL) small-for-size (SFS) grafts.METHODSProspectively collected data of adult patients who underwent LDLT at our hospital in the period from January 2003 to December 2013 were reviewed. The patients were divided into the RL-LDLT group and the LL-LDLT group. The two groups were compared in terms of short- and long-term outcomes, including incidence of postoperative complication, graft function, graft survival, and patient survival. A SFS graft was defined as a graft with a ratio of graft weight (GW) to recipient standard liver volume (RSLV) (GW/RSLV) of < 50%. The Urata formula was used to estimate RSLV.RESULTSTotally 218 patients were included for analysis, with 199 patients in the RL-LDLT group and 19 patients in the LL-LDLT group. The two groups were similar in terms of age (median, 53 years in the RL-LDLT group and 52 years in the LL-LDLT group, P = 0.997) but had significantly different ratios of men to women (165:34 in the RL-LDLT group and 8:11 in the LL-LDLT group, P < 0.0001). The two groups were also significantly different in GW (P < 0.0001), GW/RSLV (P < 0.0001), and graft cold ischemic time (P = 0.007). When it comes to postoperative complication, the groups were comparable (P = 0.105). Five patients died in hospital, 4 (2%) in the RL-LDLT group and 1 (5.3%) in the LL-LDLT group (P = 0.918). There were 38 graft losses, 33 (16.6%) in the RL-LDLT group and 5 (26.3%) in the LL-LDLT group (P = 0.452). The 5-year graft survival rate was significantly better in the RL-LDLT group (95.2% vs 89.5%, P = 0.049). The two groups had similar 5-year patient survival rates (RL-LDLT: 86.8%, LL-LDLT: 89.5%, P = 0.476).CONCLUSIONThe use of SFS graft in LDLT requires careful tailor-made surgical planning and meticulous operation. LL-LDLT can be a good alternative to RL-LDLT with similar recipient outcomes but a lower donor risk. Further research into different patient conditions is needed in order to validate the use of LL graft.

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Section: Discussionmentioning

confidence: 73%

Outcomes of right-lobe and left-lobe living-donor liver transplantations using small-for-size grafts

She¹,

Chok²,

Chan³

et al. 2017

WJG

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“…The hemodynamic status is related to the spleen volume and the development of collateral vessels [8,19]. Although the GV/SLV and GRWR are generally accepted as important predictors of the adequacy of the post-transplant liver function (GV/SLV ≥ 35%, GRWR ≥ 0.08%) [4,6], we have encountered some patients whose post-transplant course was not good despite meeting these criteria. In our present study, all of the estimated GV/SLV values met the criterion (≥35%), but portal hyperperfusion was still found in 12 recipients (35.3%).…”

Section: Discussionmentioning

confidence: 99%

Liver graft-to-spleen volume ratio as a useful predictive factor of the early graft function in children and young adults transplanted for biliary atresia: a retrospective study

et al. 2018

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A graft volume/standard liver volume ratio (GV/SLV) > 35% or graft/recipient weight ratio (GRWR) > 0.8% has been considered as a standard criteria of graft selection. Even if the graft size meets these selection criteria, small-for-size syndrome can still occur depending on the portal venous flow (PVF). The aim of this study was to identify other factors contributing to portal hyperperfusion and the post-transplant course, focusing on the graft volume-to-spleen volume ratio (GV/SV). Thirty-seven BA patients who underwent living donor liver transplantation were reviewed retrospectively. First, we evaluated the preoperative factors contributing to portal hyperperfusion. Second, we evaluated the factors contributing to post-transplant complications, such as thrombocytopenia, hyperbilirubinemia, and coagulopathy. The GV/SLV was >35% in all cases; however, portal hyperperfusion (≥250 ml/min/100 g graft) was found in 12 recipients (35.3%). Furthermore, although the GRWR was >0.8% in over 90% of cases, portal hyperperfusion was found in 10 recipients (32.3%). In contrast, the GV/SV showed a significant correlation with the PVF after reperfusion. If the GV/SV was <0.88, about 80% of recipients developed portal hyperperfusion. Furthermore, the GV/SV also showed a significant correlation with post-transplant persistent thrombocytopenia and hyperbilirubinemia. The GV/SV < 0.88 predicts portal hyperperfusion, post-transplant persistent thrombocytopenia, and hyperbilirubinemia.

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“…

We read with great interest the article published in Liver Transplantation by Kurihara et al (1) This present article demonstrated that outcomes of recipient are not significantly different between right lobe (RL) and left lobe (LL) living donor liver transplantation (LDLT) when both lobes are available. In fact, the title of this study could somehow mislead readers to think that the study evaluates differences in outcomes of RL and LL when both lobes are appropriate for LDLT.

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confidence: 85%