Graft‐to‐recipient weight ratio threshold adjusted to the model for end‐stage liver disease score for living donor liver transplantation

Abstract

The graft-to-recipient weight ratio (GRWR) is an important selection criterion for living donor liver transplantation (LDLT). The generally accepted threshold is known to be 0.8%. We believe that this threshold can be reduced under certain conditions. The aim of this study was to evaluate the results of these patients with GRWR < 0.8%. Between 2004 and 2015, 649 patients underwent right lobe LDLT for end-stage liver disease in adult patients. All recipients who had GRWR < 0.8% were identified. The data of these patients were retrospectively analyzed and compared to patients with GRWR ≥ 0.8%. There were 43 patients with GRWR < 0.8%. Out of these patients, 7 (16%) had GRWR of 0.6%. The median Model for End-Stage Liver Disease (MELD) score was 15, and the median donor age was 30 years. Anterior segment drainage was ensured. Portal inflow modulation was performed by splenic artery ligation according to the portal flow. Postoperative complications were seen in 6 (14%) patients. Of all 43 patients, 3 (7%) died perioperatively within 1 month, and 1 (2%) patient underwent retransplantation due to graft failure. The mean hospital stay was 18 days. The 1-year survival rate was 93%. None of the patients had a laboratory MELD score above 20. The comparison of the results with the patients who had GRWR ≥ 0.8% has shown no significant difference, except MELD score, body mass index (BMI), and rate of anterior segment drainage. The GRWR can be decreased even to 0.6% if the MELD score is below 20, donor age is below 45 years, and there are no signs for any hepatosteatosis of the donor graft. In these patients, it is essential that the anterior segment drainage is secured and the portal inflow modulation is performed according to the portal flow. Liver Transplantation 22 1643-1648 2016 AASLD.

Is Portal Inflow Modulation Always Necessary for Successful Utilization of Small Volume Living Donor Liver Grafts?

“…In particular, SFSS was similar in all the groups (Tables 5 and 6), suggesting that our PIM protocol was able to effectively mitigate the higher predilection of low-GRWR grafts to SFSS. (5,7,8,30,37,38,44,45) These findings are in keeping with those of Uemura et al (44) and Kaido et al (30) The good outcomes of low-GRWR grafts in our study were related not only to optimizing postperfusion PP but also to other factors, such as younger donors (upper limit of donor age was 55 years), absence of significant steatosis, low MELD, and meticulous reconstitution of venous outflow.…”

“…We found that the postoperative complications were no different among the various GRWR groups. In particular, SFSS was similar in all the groups (Tables and ), suggesting that our PIM protocol was able to effectively mitigate the higher predilection of low‐GRWR grafts to SFSS . These findings are in keeping with those of Uemura et al and Kaido et al…”

Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: A study of 31 cases

“…We consider it as the result of the obstruction of the PV branch and the biliary tract caused by the lesion pressure, which increases the blood inflow of the disease‐free lobes. In our study, the ratio of RLV to SLV of all patients was larger than 35%, which suggested that the RLV was adequate to meet the functional demands 38. Thus if successful reconstruction of intrahepatic conduits could be managed following complete removal of the lesion, HAE might be a specific indication for ERAT that yields better results than those obtained in malignant tumor.…”

Liver paired exchange: Can the liver emulate the kidney?

“…There are 3 potential scenarios where hepatic mass may influence the decision to proceed with LPE: The donor allograft segment is small relative to recipient weight, and there is concern for early allograft dysfunction (EAD), also termed small‐for‐size syndrome. The donor allograft segment is too large for the recipient, which is more likely to occur with small pediatric recipients. The donor's estimated remnant hepatic volume is felt to be inadequate …”

“…felt to be inadequate. (27)(28)(29)(30)(31)(32) Although some centers are willing to use small grafts relative to recipient size with graft-to-recipient weight ratios (GRWRs) of <0.6%-0.8% and a graft weight/standard liver volume ratio of <40%, this has not been widely practiced. Some have advocated for performing a variety of graft inflow or pharmacological interventions to reduce portal flow in order to avoid EAD, but the value of such procedures/interventions are debated.…”