title: Outcome of using small-for-size grafts in living donor liver transplantation recipients with high model for end-stage liver disease scores: a single center experience.
abstract: OBJECTIVE
  To evaluate the impact of small-for-size grafts (SFSG) in adult-to-adult living donor liver transplantation (AALDLT) on outcomes of recipients with different model for end-stage liver disease (MELD) score in a single liver transplant center.
  
  
  METHODS
  Clinical data of 118 patients underwent right-lobe AALDLT from January 2004 to December 2011 were retrospectively analyzed, Patients were divided into Group L (MELD score ≤ 25) and Group H (MELD score > 25) according to MELD score. The patients were further stratiﬁed into Group LS (MELD score ≤ 25, GBWR < 0.8%), Group LN (MELD score ≤ 25, GBWR ≥ 0.8%), Group HS (MELD score > 25, GBWR < 0.8%), and Group HN (MELD score > 25, GBWR ≥ 0.8%) to investigate the impact of graft size on recipients' complications and outcomes. Pre-operative characteristics, post-operative complications graded by the Clavien score and patient survival were analyzed.
  
  
  RESULTS
  MELD scores between the two groups were significant different (12.4 ± 4.9 vs 34.5 ± 7.5, P = 0.026). There was no significant difference in preoperative demographic data as well as postoperative liver function. Complication rate, length of ICU and hospital stay, graft loss, and mortality were similar in both groups. The 1- and 3- year survival were similar between group H and group L. When recipients were further stratified into group LS, LN, HS, and HN, no significant difference was found among groups in 1- and 3- year survival rate. In multivariate analysis, HCC was not a predictor for long term survival.
  
  
  CONCLUSIONS
  Our single institution experience demonstrates that it is safe to use SFSGs in high pre-MELD score recipients with the improvement of intensive care and the selection of listing criteria.
authors.affiliation: Department of Liver and Vascular Surgery, Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: HongYu
authors.initials: H
authors.lastname: Li
authors.forename: Bo
authors.initials: B
authors.lastname: Li
authors.forename: YongGang
authors.initials: Y
authors.lastname: Wei
authors.forename: LvNan
authors.initials: L
authors.lastname: Yan
authors.forename: TianFu
authors.initials: T
authors.lastname: Wen
authors.forename: MingQing
authors.initials: M
authors.lastname: Xu
authors.forename: WenTao
authors.initials: W
authors.lastname: Wang
authors.forename: JiaYin
authors.initials: J
authors.lastname: Yang
mesh_terms: D000328:Adult; D058625:End Stage Liver Disease / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome; D055815:Young Adult
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