Graft weight/recipient weight ratio: How well does it predict outcome after partial liver transplants?

Hill, Mark J.; Hughes, Michael G.; Jie, Tun; Cohen, Melissa; Lake, John R.; Payne, William D.; Humar, Abhinav

doi:10.1002/lt.21846

Cited by 86 publications

(78 citation statements)

References 18 publications

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“…Another important factor leading to SFSS is portal venous hypertension (Shimamura et al, 2001). In recent study by Hill et al, GW/RW did not appear to be the only determinant of outcome after partial liver transplantation and the occurrence of SFSS was influenced not only by the graft size but also by other factors such as the degree of portal hypertension as well (Hill et al, 2009). For adult patient receiving right lobe graft, low intraoperative body temperature, graft size of < 35% of the estimated standard graft weight, and middle hepatic vein occlusion were significantly independent factors in determining hospital mortality (Fan et al, 2003).…”

Section: Small-for-size Syndrome (Sfss)mentioning

confidence: 82%

Initial Poor Graft Dysfunction and Primary Graft Non-Function After Orthotopic Liver Transplantation

Chen¹,

Xie²,

Shen³

et al. 2011

Liver Biopsy in Modern Medicine

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Section: Small-for-size Syndrome (Sfss)mentioning

confidence: 82%

Initial Poor Graft Dysfunction and Primary Graft Non-Function After Orthotopic Liver Transplantation

Chen¹,

Xie²,

Shen³

et al. 2011

Liver Biopsy in Modern Medicine

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“…Nevertheless, transplantation centers are also considering smaller grafts, with improved outcomes under refined and established surgical techniques (11)(12)(13)(14). Indeed, recent studies have documented that small grafts do not necessarily cause or correspond to PGD, which is attributed to multiple factors including disease severity, portal pressure, graft regeneration and donor age (15).…”

Section: Introductionmentioning

confidence: 99%

Primary Graft Dysfunction After Living Donor Liver Transplantation Is Characterized by Delayed Functional Hyperbilirubinemia

Ikegami

Shirabe²,

Yoshizumi³

et al. 2012

American Journal of Transplantation

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The purpose of this study is to propose a new concept of primary graft dysfunction (PGD) after living donor liver transplantation (LDLT), characterized by delayed functional hyperbilirubinemia (DFH) and a high early graft mortality rate. A total of 210 adult-to-adult LDLT grafts without anatomical, immunological or hepatitisrelated issues were included. All of the grafts with early mortality (n = 13) caused by PGD in LDLT had maximum total bilirubin levels >20 mg/dL after postoperative day 7 (p < 0.001). No other factors, including prothrombin time, ammonia level or ascites output after surgery were associated with early mortality. Thus, DFH of >20 mg/dL for >seven consecutive days occurring after postoperative day 7 (DFH-20) was used to characterize PGD. DFH-20 showed high sensitivity (100%) and specificity (95.4%) for PGD with early mortality. Among the grafts with DFH-20 (n = 22), those with early mortality (n = 13) showed coagulopathy (PT-INR > 2), compared with those without mortality (p = 0.002). Pathological findings in the grafts with DFH-20 included hepatocyte ballooning and cholestasis, which were particularly prominent in the centrilobular zone. PGD after LDLT is associated with DFH-20 caused by graft, recipient and surgical factors, and increases the risk of early graft mortality.

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“…[3][4][5] In pediatric liver transplant, the use of an LFSG (GBWR > 4%) may cause graft damage such as vascular complications and necrosis due to an insufficient blood supply to the graft. 6,7 The main problem with an LFSG may include the risk of abdominal compartment syndrome due to the small size of the recipient abdominal cavity, size discrepancies in vascular caliber, insufficient portal circulation, and disturbance of tissue oxygenation.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2015

Exp Clin Transplant

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Objectives: The ideal ratio between liver transplant graft mass and recipient body weight is unknown, but the graft probably must weigh 0.8% to 2.0% recipient weight. When this ratio > 4%, there may be problems due to large-for-size transplant, especially in recipients < 10 kg. This condition is caused by discrepancy between the small abdominal cavity and large graft and is characterized by decreased blood supply to the liver graft and graft dysfunction. We evaluated our experience with large-for-size grafts. Materials and Methods: We retrospectively evaluated 377 orthotopic liver transplants that were performed from 2001-2014 in our center. We included 188 pediatric transplants in our study. Results: There were 58 patients < 10 kg who had living-donor living transplant with graft-to-bodyweight ratio > 4%. In 2 patients, the abdomen was closed with a Bogota bag. In 5 patients, reoperation was performed due to vascular problems and abdominal hypertension, and the abdomen was closed with a Bogota bag. All Bogota bags were closed in 2 weeks. After closing the fascia, 10 patients had vascular problems that were diagnosed in the operating room by Doppler ultrasonography, and only the skin was closed without fascia closure. No graft loss occurred due to large-for-size transplant. There were 8 patients who died early after transplant (sepsis, 6 patients; brain death, 2 patients). There was no major donor morbidity or donor mortality. Conclusions: Large-for-size graft may cause abdominal compartment syndrome due to the small size of the recipient abdominal cavity, size discrepancies in vascular caliber, insufficient portal circulation, and disturbance of tissue oxygenation. Abdominal closure with a Bogota bag in these patients is safe and effective to avoid abdominal compartment syndrome. Early diagnosis by ultrasonography in the operating room after fascia closure and repeated ultrasonography at the clinic may help avoid graft loss.

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Graft weight/recipient weight ratio: How well does it predict outcome after partial liver transplants?

Cited by 86 publications

References 18 publications

Initial Poor Graft Dysfunction and Primary Graft Non-Function After Orthotopic Liver Transplantation

Initial Poor Graft Dysfunction and Primary Graft Non-Function After Orthotopic Liver Transplantation

Primary Graft Dysfunction After Living Donor Liver Transplantation Is Characterized by Delayed Functional Hyperbilirubinemia

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