title: Effect of graft size matching on pediatric living-donor liver transplantation in Japan.
abstract: OBJECTIVE
  The Japanese Liver Transplantation Society is a cooperative research consortium, established in 1980 to characterize and follow trends in patient and graft survival in all liver transplants in Japan. This study evaluated the effect of graft size matching on survival in pediatric recipients of living donor liver transplant.
  
  
  METHODS
  Between November 1989 and December 2010, there were 2224 patients aged < 18 years who received living-donor liver transplant in Japan. Survival was evaluated according to graft size matching.
  
  
  RESULTS
  There were 998 male and 1226 female donors (median age, 35.2 y). There was no donor mortality associated with surgery. The median age of recipients was 4.0 years (range, 13 d to 17.9 y) and body weight was 16.6 kg (range, 2.6 to 90 kg). The survival of living-donor liver transplant recipients was greater for pediatric than adult recipients at 1 year (adult, 81%; pediatric, 88%), 5 years (adult, 72%; pediatric, 85%), 10 years (adult, 66%; pediatric, 83%), and 15 years (adult, 57%; pediatric, 80%) after transplant (difference between adult and pediatric recipients: P ≤ .0001). In the 2224 recipients aged < 18 years, the graft types included left lateral segment in 1549 recipients (70%), left lobe in 500 recipients (23%), reduced left lateral segment in 96 recipients (4%), right lobe in 76 recipients (3%), and posterior segment in 3 recipients (0.1%). There was no significant difference in survival between recipients that had different graft types. However, recipients aged < 1 year (296 recipients) who received grafts with graft-to-recipient body weight ratio > 4.0% had significantly worse patient survival because of problems associated with large-for-size grafts.
  
  
  CONCLUSIONS
  Living-donor liver transplant had greater survival in children than adult recipients. Graft-to-recipient body weight ratio was a significant prognostic factor in recipients aged < 1 year.
authors.affiliation: Japanese Liver Transplantation Society, Osaka, Japan.
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
authors.forename: Seisuke
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Koji
authors.initials: K
authors.lastname: Umeshita
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D019520:Living Donors / Q000600:supply & distribution*; D008297:Male; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome