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

Abstract

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.

A systematic review of small for size syndrome after major hepatectomy and liver transplantation

“…Sanefuji et al reported that SFSS occurred in patients with GV/SLV <40% and this finding has been confirmed by others. 2,28 Ikegami et al also found no association between SFSS and GV/SLV or GRWR and these authors highlighted the issue of over predicting GV. 30 The authors found that actual graft volume was significantly lower than expected.…”

“…17 Interestingly, two studies found that splenic volume was a better predictor of SFSS than GV/SLV and GRWR. 28,33 Osman et al showed that PVP >15 mmHg and GRWR <0.8 in combination more reliably predicts SFSS (OR 10.0, p = 0.001). 19 Studies have focused on the upper limit of PVP and most have aimed for either PVP <15 mmHg or PVP <20 mmHg.…”

“…All studies included data on the development of SFSS or PHLF (including SFSS), according to whether they were, [16][17][18][19][20][21][22][23] whilst six studies utilised the following; bilirubin >10 mg/dL on postoperative day (POD) 14 alongside intractable ascites (>1000 mls/day on POD14 or >500 mls/day on POD28). 3,15,[24][25][26][27] Three studies used a similar definition with bilirubin >5 mg/ dL 2,28,29 and one study increased the bilirubin cut off to >20 mg/ dL. 30 Two studies used definitions of prolonged cholestasis, coagulopathy and intractable ascites and did not state specific numerical cut offs.…”

Preventing Small-for-size Syndrome in Living Donor Liver Transplantation: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference

“…There is some evidence that graft-to-spleen-volume-ratio (GSVR) may guide decision on the need for PIM. [145][146][147][148][149] Gyoten et al reported that GSVR <0.95 predicts PVP of >20 mm Hg. 150 Cheng et al reported a GSVR of <0.60 was highly associated with post-transplant elevated PVF.…”

Feasibility of using marginal liver grafts in living donor liver transplantation

“…Recipients with a final portal vein pressure (PVP) ≤ 15 mmHg or a pressure gradient of PVP-central vein pressure (CVP) ≤ 5 mmHg have a better prognosis[ 43 ]. In another study, liver-graft-to-spleen-volume ratio was used to predict early graft function in children and young adults undergoing LDLT, in which < 0.88 predicted portal hyperperfusion[ 44 ]. Moreover, a MELD score > 20[ 45 ], a decline in the platelet (PLT) count at post operation day (POD) 3 > 56%[ 46 ] and donor age > 45 years are also risk factors for a poor prognosis in recipients of small-for-size grafts[ 19 ].…”