title: Large-for-size liver transplant: a single-center experience.
abstract: OBJECTIVE
  The ideal ratio between liver transplant graft mass and recipient body weight is unknown, but the graft probably must weigh 0.8% to 2.0% recipient weight. When this ratio > 4%, there may be problems due to large-for-size transplant, especially in recipients < 10 kg. This condition is caused by discrepancy between the small abdominal cavity and large graft and is characterized by decreased blood supply to the liver graft and graft dysfunction. We evaluated our experience with large-for-size grafts.
  
  
  METHODS
  We retrospectively evaluated 377 orthotopic liver transplants that were performed from 2001-2014 in our center. We included 188 pediatric transplants in our study.
  
  
  RESULTS
  There were 58 patients < 10 kg who had living-donor living transplant with graft-to-bodyweight ratio > 4%. In 2 patients, the abdomen was closed with a Bogota bag. In 5 patients, reoperation was performed due to vascular problems and abdominal hypertension, and the abdomen was closed with a Bogota bag. All Bogota bags were closed in 2 weeks. After closing the fascia, 10 patients had vascular problems that were diagnosed in the operating room by Doppler ultrasonography, and only the skin was closed without fascia closure. No graft loss occurred due to large-for-size transplant. There were 8 patients who died early after transplant (sepsis, 6 patients; brain death, 2 patients). There was no major donor morbidity or donor mortality.
  
  
  CONCLUSIONS
  Large-for-size graft may cause abdominal compartment syndrome due to the small size of the recipient abdominal cavity, size discrepancies in vascular caliber, insufficient portal circulation, and disturbance of tissue oxygenation. Abdominal closure with a Bogota bag in these patients is safe and effective to avoid abdominal compartment syndrome. Early diagnosis by ultrasonography in the operating room after fascia closure and repeated ultrasonography at the clinic may help avoid graft loss.
authors.affiliation: From the Department of General Surgery, Baskent University, Ankara, Turkey.
authors.forename: Aydincan
authors.initials: A
authors.lastname: Akdur
authors.forename: Mahir
authors.initials: M
authors.lastname: Kirnap
authors.forename: Figen
authors.initials: F
authors.lastname: Ozcay
authors.forename: Atilla
authors.initials: A
authors.lastname: Sezgin
authors.forename: Hatice Ebru
authors.initials: HE
authors.lastname: Ayvazoglu Soy
authors.forename: Feza
authors.initials: F
authors.lastname: Karakayali Yarbug
authors.forename: Sedat
authors.initials: S
authors.lastname: Yildirim
authors.forename: Gokhan
authors.initials: G
authors.lastname: Moray
authors.forename: Gulnaz
authors.initials: G
authors.lastname: Arslan
authors.forename: Mehmet
authors.initials: M
authors.lastname: Haberal
mesh_terms: D001835:Body Weight; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D008297:Male; D009929:Organ Size; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey