Section 7. A new therapeutic strategy on portal flow modulation that increases donor safety with good recipient outcomes.
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 the left lobe graft in adult-to-adult living donor liver transplantation in combination with portal pressure control. Beginning December 2007, the acceptable limit for GRWR was lowered to ≥0.7% and by April 2009, it was further lowered to ≥0.6%. A portal pressure control program targeting a final portal pressure <15 mm Hg was also introduced. The donor complication rate decreased from 13.8% to 9.3%. The overall survival of recipients with GRWR <0.8% did not differ from recipients with a GRWR ≥0.8%. In conclusion, the lower limit of the GRWR can be safely reduced to 0.6% using a left lobe graft in adult-to-adult living donor liver transplantation in combination with portal pressure control.
1 Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 2 Department of Transplant Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan. 3 Address correspondence to: Toshimi Kaido, M.D., Ph.D., Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
Toshimi
T
Kaido
Kohei
K
Ogawa
Yasuhiro
Y
Fujimoto
Takashi
T
Ito
Koji
K
Tomiyama
Akira
A
Mori
Yasuhiro
Y
Ogura
Shinji
S
Uemoto
D000328:Adult; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008102:Liver Circulation; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D017082:Portal Pressure; D011169:Portal Vein / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome