title: Outcome analysis in adult-to-adult living donor liver transplantation using the left lobe.
abstract: Graft size problems remain the greatest limiting factor for expansion of living donor liver transplantation (LDLT) to the adult population. The result of adult-to-adult LDLT using the left lobe with special reference to graft size has not been fully evaluated to date. In this study, we evaluated the outcome of adult-to-adult LDLT using the left lobe and also analyze the impact of using small-for-size grafts on outcome. Thirty-six recipients who underwent adult-to-adult LDLT using the left lobe (n = 14) or left lobe plus caudate lobe (n = 22) were included in the study. Variables including preoperative and operative data, patient and graft survival, complications, and causes of graft loss were studied. Furthermore, the incidence of small-for-size syndrome and its impact on graft survival were studied. Mean graft volume (GV) was 420 +/- 85 g (range, 260 to 620 g), which resulted in 38.2% +/- 8.1% (range, 22.8% to 53.8%) of the recipient standard liver volume (SLV). Overall 1-year patient and graft survival rates were 85.7% and 82.9%, respectively. Seven grafts were lost. Small-for-size syndrome occurred in 7 of 16 patients (43.8%) with cirrhosis and only 1 of 20 patients (5.0%) without cirrhosis (P =.005). Recipients who developed small-for-size syndrome had inferior graft survival to those who did not (P =.07). In conclusion, adult-to-adult LDLTs were found to be feasible without affecting patient or graft survival. Small-for-size syndrome developed more frequently in patients with cirrhosis. Minimum GV in adult-to-adult LDLT should be 30% less than the recipient's SLV in patients without cirrhosis, whereas 45% less was required in patients with cirrhosis.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. ysoejima@surg2.med.kyushu-u.ac.jp
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.forename: Taketoshi
authors.initials: T
authors.lastname: Suehiro
authors.forename: Shoji
authors.initials: S
authors.lastname: Hiroshige
authors.forename: Mizuki
authors.initials: M
authors.lastname: Ninomiya
authors.forename: Satoko
authors.initials: S
authors.lastname: Shiotani
authors.forename: Noboru
authors.initials: N
authors.lastname: Harada
authors.forename: Ijichi
authors.initials: I
authors.lastname: Hideki
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yonemura
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000401:mortality* / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality*; D019520:Living Donors / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011183:Postoperative Complications / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome