Size mismatch in liver transplantation

Fukazawa, Kyota; Nishida, Seigo

doi:10.1002/jhbp.371

Cited by 41 publications

(54 citation statements)

References 87 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: 91%

“…This finding may be explained by an increase in intra-abdominal and intrathoracic pressures, atelectasis, and respiratory failure. 4 In addition, the large-for-size group in our study received more blood product transfusions. This finding may be explained by hypotension due to external compression of the venous system and distribution of volume into the graft.…”

Section: Discussionmentioning

confidence: 81%

“…Release of inflammatory mediators by the ischemic tissue and distribution of volume into the graft may explain this hemodynamic instability. 4 This mechanism may also explain the greater need for colloid fluids and furosemide administration in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…liver transplant, 4,5 there are also serious adverse outcomes related to a large-for-size graft, including increased intra-abdominal and intrathoracic pressures, atelectasis formation, prolonged intubation, decreased cardiac output, hypotension, and kidney and graft injury related to decreased perfusion. In addition, the need for high levels of antigen in largefor-size grafts is associated with a high incidence of rejection.…”

Section: Discussionmentioning

confidence: 99%

“…2 A mismatch in graft size versus patient size is a rare but critical issue in livingdonor liver transplant. 4 Small-for-size grafts are associated with poor graft survival. Postoperative graft dysfunction caused by a graft that is insufficiently sized to maintain adequate liver function presents as cholestasis, coagulopathy, portal hypertension, sepsis, variceal bleeding, respiratory failure, acute kidney dysfunction, intestinal perforation, and mortality.…”

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: 91%

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ersoy

Kaplan²,

Özdemirkan³

et al. 2017

Exp Clin Transplant

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Extreme large‐for‐size syndrome after adult liver transplantation: A model for predicting a potentially lethal complication

et al. 2017

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There is currently no tool available to predict extreme large-for-size (LFS) syndrome, a potentially disastrous complication after adult liver transplantation (LT). We aimed to identify the risk factors for extreme LFS and to build a simple predictive model. A cohort of consecutive patients who underwent LT with full grafts in a single institution was studied. The extreme LFS was defined by the impossibility to achieve direct fascial closure, even after delayed management, associated with early allograft dysfunction or nonfunction. Computed tomography scan-based measurements of the recipient were done at the lower extremity of the xiphoid. After 424 LTs for 394 patients, extreme LFS occurred in 10 (2.4%) cases. The 90-day mortality after extreme LFS was 40.0% versus 6.5% in other patients (P = 0.003). In the extreme LFS group, the male donor-female recipient combination was more often observed (80.0% versus 17.4%; P < 0.001). The graft weight (GW)/right anteroposterior (RAP) distance ratio was predictive of extreme LFS with the highest area under the curve (area under the curve, 0.95). The optimal cutoff was 100 (sensitivity, 100%; specificity, 88%). The other ratios based on height, weight, body mass index, body surface area, and standard liver volume exhibited lower predictive performance. The final multivariate model included the male donor-female recipient combination and the GW/RAP. When the GW to RAP ratio increases from 80, 100, to 120, the probability of extreme LFS was 2.6%, 9.6%, and 29.1% in the male donor-female recipient combination, and <1%, 1.2%, and 4.5% in other combinations. In conclusion, the GW/RAP ratio predicts extreme LFS and may be helpful to avoid futile refusal for morphological reasons or to anticipate situation at risk, especially in female recipients. Liver Transplantation 23 1294-1304 2017 AASLD.

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Large-for-Size Orthotopic Liver Transplantation: a Systematic Review of Definitions, Outcomes, and Solutions

Addeo

Noblet

Naegel

et al. 2020

Journal of Gastrointestinal Surgery

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Background:We systematically reviewed the literature on definitions and outcomes of large-forsize (LFS) syndrome in orthotopic liver transplantation (LT).Methods: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Cochrane library, PUBMED, and Embase were searched (January 1990-January 2019) for studies reporting LFS in LT. Primary outcomes were definitions and mortality of LFS LT.Results: Eleven studies reporting patients with LFS LT were identified. Four different formulas (Graft-recipient weight ratio (GRWR), Body surface area index (BSAi), Donor standardized total liver volume (sTLV)-recipient sTLV ratio, and Graft-weight/Right anteroposterior distance (RAP) ratio) with their critical thresholds were found. There were 81 patients (54% women) with a median weight and height of 62.5 kg (range, 40-105 kg) and 165 cm (range, 145-180 cm). The median graft weight was 1772 g (range, 1290-2400 g), and the median GWRW was 2.77% (range, 2. 1-4.00%). Graft venous outflow obstruction was described in seven patients(8.6%). At the time of LT, fascial closure was not achieved in 24 patients (29.6%) and the graft size was reduced by a liver resection in three patients(3.7%). Thirteen deaths (16%) were reported in the first 90 postoperative days with two patients undergoing re-transplant.Conclusions: LFS LT remains heterogeneously defined but characterized by high mortality rates despite the use of tailored surgical solutions (graft reduction and open abdomen). A composite definition is proposed in order to better describe LFS clinical syndrome.

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Size mismatch in liver transplantation

Cited by 41 publications

References 87 publications

Untitled

Untitled

Extreme large‐for‐size syndrome after adult liver transplantation: A model for predicting a potentially lethal complication

Large-for-Size Orthotopic Liver Transplantation: a Systematic Review of Definitions, Outcomes, and Solutions

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