Graft-to-recipient weight ratio lower to 0.7% is safe without portal pressure modulation in right-lobe living donor liver transplantation with favorable conditions.
BACKGROUND
The low graft-to-recipient weight ratio (GRWR) in adult-to-adult living donor liver transplantation (LDLT) is one of the major risk factors affecting graft survival. The goal of this study was to evaluate whether the lower limit of the GRWR can be safely reduced without portal pressure modulation in right-lobe LDLT.


METHODS
From 2005 to 2011, 317 consecutive patients from a single institute underwent LDLT with right-lobe grafts without portal pressure modulation. Of these, 23 had a GRWR of less than 0.7% (group A), 27 had a GRWR of ≥0.7%, <0.8% (group B), and 267 had a GRWR of more than and equal to 0.8% (group C). Medical records, including recipient, donor, operation factors, laboratory findings and complications were reviewed retrospectively.


RESULTS
The baseline demographics showed low model for end-stage liver disease score (mean 16.3+/-8.9) and high percentage of hepatocellular carcinoma (231 patients, 72.9%). Three groups by GRWR demonstrated similar characteristics except recipient body mass index and donor gender. For small-for-size syndrome, there were 3 (13.0%) in group A, 1 (3.7%) in group B, and 2 patients (0.7%) in group C (P<0.001). Hepatic artery thrombosis was more frequently observed in group A than in groups B and C (8.7% vs 3.7% vs 1.9%, P=0.047). However, among the three groups, graft survival rates at 1 year (100% vs 96.3% vs 93.6%) and 3 years (91.7% vs 73.2% vs 88.1%) were not different (P=0.539). In laboratory measurements, there was no group difference in total bilirubin and albumin. However, prothrombin time was longer in group A within postoperative 1 week and platelet count was lower in groups A and B within postoperative 1 month.


CONCLUSIONS
A GRWR lower to 0.7% is safe and does not need to modulate portal pressure in adult-to-adult LDLT using the right-lobe in favorable conditions including low model for end-stage liver disease score.
Center for Liver Cancer, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea. kshlj@ncc.re.kr.
Seung Duk
SD
Lee
Seong Hoon
SH
Kim
Young-Kyu
YK
Kim
Soon-Ae
SA
Lee
Sang-Jae
SJ
Park
D000328:Adult; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology*; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D058625:End Stage Liver Disease / Q000601:surgery; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D008099:Liver / Q000033:anatomy & histology* / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D017082:Portal Pressure / Q000502:physiology*; D012189:Retrospective Studies; D066027:Transplant Recipients; D016896:Treatment Outcome