Prognosis of adult patients transplanted with liver grafts < 35% of their standard liver volume.
We have previously reported that a graft volume (GV) > 30% of the recipient's standard liver volume (SLV) can meet the recipient's metabolic demands. Here we report our experience with adult-to-adult living donor liver transplantation using left side grafts < 35% of the recipient's SLV. Of 143 adult living donor liver transplants, 13 auxiliary partial orthotopic liver transplants, 8 right side grafts, and 2 retransplantation cases were excluded. The resulting 120 cases were divided into 2 groups: group S consisted of 33 patients who received liver grafts < 35% of their SLV, and group L consisted of 87 patients who received liver grafts > or = 35% of their SLV. Patient characteristics, postoperative liver function, duration of hospital stay, and recipient survival rates were compared between the 2 groups. There were no significant differences between groups in recipient or donor background characteristics. The mean GV/SLV ratio of group S was 31.8%, whereas that of group L was 42.5%. There were no significant differences in the postoperative serum total bilirubin levels, prothrombin time international normalized ratio, daily ascites volume, or duration of postoperative hospital stay between the groups. The 1- and 5-year survival rates in group S were 80.7% and 64.2%, respectively, whereas those of group L were 90.8% and 84.9%, respectively, with no significant difference between groups. In conclusion, graft size was not considered to be the only cause of so-called small-for-size graft syndrome, and left side grafting appears to be the procedure of choice for adult-to-adult living donor liver transplantation because of the lower risk to donors in comparison with right lobe grafting.
Ikegami
Toshihiko
T
Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Masuda
Yuichi
Y
Ohno
Yasunari
Y
Mita
Atsushi
A
Kobayashi
Akira
A
Urata
Koichi
K
Nakazawa
Yuichi
Y
Miwa
Shirou
S
Hashikura
Yasuhiko
Y
Miyagawa
Shinichi
S
D000328:Adult; D002423:Cause of Death; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008099:Liver / Q000502:physiology; D017093:Liver Failure / Q000401:mortality* / Q000601:surgery*; D008115:Liver Regeneration; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality*; D019520:Living Donors / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate