title: Using low graft/recipient's body weight ratio graft with portal flow modulation an effective way to prevent small-for-size syndrome in living-donor liver transplant: a retrospective analysis.
abstract: OBJECTIVE
  Small-sized grafts are associated with high rates of graft failure and small-for-size syndrome. Portal flow is a causative factor for small-for-size syndrome. We sought to evaluate early graft dysfunction in smaller-sized grafts and the study factors responsible for it.
  
  
  METHODS
  A total of 450 patients underwent a living-donor liver transplant from January 2010 to June 2013. Fifty-four grafts with graft/recipient's body weight ratio less than 0.8 were included in the study. We used a splenic artery ligation or splenectomy for portal flow modulation if the portal flow after reperfusion was greater than 250 mL/min/100 g. Small-for-size syndrome was defined according to Clavien and Kyushu university definitions. Portal flow was measured with Doppler ultrasound flowmetry. Factors responsible for early graft dysfunction also were analyzed.
  
  
  RESULTS
  Six patients out of 54 developed small-for-size syndrome in smaller size group (graft/recipient's body weight ratio < 0.8). There were 28 left lobe grafts and 26 right lobe grafts. Sixteen out of 132 patients from the control group fulfilled the definitions of small-for-size syndrome. There was no statistical significant difference in graft dysfunction between low graft/recipient's body weight ratio group and high graft/recipient's body weight ratio group. On univariate analysis Hepatitis C, Hepatitis B and HCC as etiologies, Model for End-stage Liver diease score, and portal flow achieved statistical significane as factors associated with graft dysfunction (P < .05). On multivariate analysis, only portal flow achieved statistical significance.
  
  
  CONCLUSIONS
  Lower graft/recipient's body weight ratio graft with portal flow modulation in case of high portal flow is an effective way to increase donor pool and donor safety with low risk of small-for-size syndrome. Portal flow is mainly responsible for small-for-size syndrome or early graft dysfunction.
authors.affiliation: From the Department of Hepatobiliary Surgery and Liver Transplantation, Continental Hospital, Hyderabad, India.
authors.forename: Bhavin
authors.initials: B
authors.lastname: Vasavada
authors.forename: Chao Long
authors.initials: CL
authors.lastname: Chen
authors.forename: Muhammad
authors.initials: M
authors.lastname: Zakaria
mesh_terms: D000328:Adult; D001835:Body Weight; D016009:Chi-Square Distribution; D005260:Female; D006085:Graft Survival; D006801:Humans; D008026:Ligation; D008102:Liver Circulation; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009929:Organ Size; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013156:Splenectomy / Q000009:adverse effects; D013157:Splenic Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D055815:Young Adult