title: Portal flow is the main predictor of early graft dysfunction regardless of the GRWR status in living donor liver transplantation - a retrospective analysis of 134 patients.
abstract: BACKGROUND
  Sometimes even in adequate graft to recipient weight ratio (GRWR) settings and after ruling out all other causes, recipients still show features of the small for size syndrome. The purpose of this study was to evaluate all causative factors responsible for early graft dysfunction fulfilling the definition of the small for size syndrome, regardless of the GRWR status, and with particular emphasis on portal flow (ml/min/100 g). We also tried to establish whether a high portal flow on intraoperative Doppler study immediately after reperfusion can predict graft dysfunction.
  
  
  METHODS
  Early graft dysfunction was defined according to the definitions given for the small for size syndrome by the Kyushu University Group. Patients undergone living donor liver transplantations between January 2010 and December 2012 were analyzed. We routinely do Doppler ultrasound (USG) immediately after reperfusion and daily for 5 days. The portal vein flow after routine Doppler examination immediately after reperfusion was noted as the portal vein flow at day 0.
  
  
  RESULTS
  19 of 134 patients showed features of early graft dysfunction as defined. On univariate analysis, hepatitis C virus (HCV) and portal vein flow immediately after reperfusion were significant predictors of postoperative graft dysfunction. (p = 0.008 and p < 0.0001). On multivariate logistic regression, only portal vein flow after reperfusion (p = 0.002) remained as the significant predictor of postoperative graft dysfunction. A portal flow of greater than 190 (ml/min/100 g) was significant in predicting graft dysfunction (p < 0.0001) with an AUROC of 0.709. GRWR was not a significant predictor.
  
  
  CONCLUSIONS
  A portal vein flow immediately after reperfusion >190/ml/min/100 g. reliably predicted whether a graft would behave as small for size or not, regardless of the GRWR status. Portal vein flow was the most significant predictor of graft dysfunction.
authors.affiliation: Liver Surgery and Liver Transplant, Chang Gung Memorial Hospital, Kaohsiung, Taiwan. Electronic address: Bhavu279@yahoo.com.
authors.forename: Bhavin B
authors.initials: BB
authors.lastname: Vasavada
authors.affiliation: Liver Surgery and Liver Transplant, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Chao Long
authors.initials: CL
authors.lastname: Chen
authors.affiliation: Liver Surgery and Liver Transplant, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Zakaria
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008099:Liver / Q000098:blood supply*; D008102:Liver Circulation / Q000502:physiology*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011168:Portal System / Q000503:physiopathology*; D055031:Primary Graft Dysfunction / Q000209:etiology*; D012372:ROC Curve; D012189:Retrospective Studies
keywords: GRWR; Graft dysfunction; Portal flow; Small for size syndrome