title: Lower limit of the graft-to-recipient weight ratio can be safely reduced to 0.6% in adult-to-adult living donor liver transplantation in combination with portal pressure control.
abstract: BACKGROUND
  The goal of this study was to examine whether the lower limit of the graft-to-recipient weight ratio (GRWR) can be safely reduced to make better use of a left-lobe graft in adult-to-adult living donor liver transplantation (LDLT) in combination with portal pressure control.
  
  
  METHODS
  Beginning in December 2007, our institution actively selected left-lobe grafts for use in liver transplantation seeking to minimize the risks to healthy donors. We gradually decreased the lower limit of the GRWR to preferentially select a left-lobe over a right-lobe graft: from ≥0.7% beginning in December 2007 to ≥0.6% beginning in April 2009. A portal pressure control program, targeting final portal pressures below 15 mm Hg, was also introduced to overcome small-for-size graft problems. The ratio of left-lobe grafts among all adult-to-adult LDLT grafts and the donor complication rate (defined as Clavien grade ≥ III, excluding wound infection) were compared between two time periods: June 1999 to November 2007 (period 1, n = 541) and December 2007 to February 2010 (period 2, n = 119). Overall survival rates were also compared between those recipients of a GRWR < 0.8% and those with a GRWR ≥ 0.8% in 198 recipients who underwent LDLT at our institution between April 2006 and February 2010.
  
  
  RESULTS
  Left-lobe grafts use increased from period 1 (65/541 recipients; 12.0%) to period 2 (50/119 recipients; 42.0%; P < .001). The donor complication rate tended to decrease from 13.8% in period 1 to 9.3% in period 2 (P = .115). The overall survival rate in 52 recipients with a GRWR < 0.8% did not differ from that in 146 recipients with a GRWR ≥ 0.8%.
  
  
  CONCLUSIONS
  The lower limit of the GRWR can be safely reduced to 0.6% in adult-to-adult LDLT in combination with portal pressure control.
authors.affiliation: Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. kaido@kuhp.kyoto-u.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Kaido
authors.forename: A
authors.initials: A
authors.lastname: Mori
authors.forename: Y
authors.initials: Y
authors.lastname: Ogura
authors.forename: K
authors.initials: K
authors.lastname: Hata
authors.forename: A
authors.initials: A
authors.lastname: Yoshizawa
authors.forename: T
authors.initials: T
authors.lastname: Iida
authors.forename: S
authors.initials: S
authors.lastname: Yagi
authors.forename: S
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D019520:Living Donors; D009929:Organ Size; D017082:Portal Pressure; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome