title: Durability of small-for-size living donor allografts.
abstract: Our aim was to study the long-term outcomes of living donor liver transplantation using small-for-size (SFS) grafts. From July 2002 to July 2009, 233 patients received a right liver graft with a middle hepatic vein from a living donor in our center. Recipients were stratified according to the graft weight to recipient standard liver volume (GW/SLV) ratio into 4 groups: >50% (n = 89), >40% to 50% (n = 85), >35% to 40% (n = 38), and ≤ 35% (n = 21). They were compared in terms of graft survivals, biliary stricture rates, renal function in terms of estimated glomerular filtration rate (eGFR), platelet counts, and graft function in terms of serum bilirubin and international normalized ratio (INR). The 5-year graft survivals for patients with GW/SLV of >50%, >40% to 50%, >35% to 40% and ≤ 35% were 88.8%, 88.2%, 81.5%, and 81.0%, respectively. Transplantation for hepatocellular carcinoma affected graft survivals (P = 0.02), but graft size did not (P = 0.66). There were no differences in frequency of biliary stricture (21.3% versus 17.1% versus 21.1% versus 28.6%; P = 0.75). At each year after transplant, their platelet counts (P = 0.12-0.65), eGFR (P = 0.49-0.91), bilirubin (P = 0.14-0.51), and INR (P = 0.20-0.98) remained comparable. SFS grafts with GW/SLV ≤ 35% and >35% to 40% had comparable long-term outcomes with larger liver grafts. Graft size did not affect long-term graft survivals.
authors.affiliation: Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong.
authors.forename: Kin Pan
authors.initials: KP
authors.lastname: Au
authors.affiliation: Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong.
authors.forename: See Ching
authors.initials: SC
authors.lastname: Chan
authors.affiliation: Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong.
authors.forename: Kenneth Siu Ho
authors.initials: KS
authors.lastname: Chok
authors.affiliation: Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong.
authors.forename: Albert Chi Yan
authors.initials: AC
authors.lastname: Chan
authors.affiliation: Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong.
authors.forename: Tiffany Cho Lam
authors.initials: TC
authors.lastname: Wong
authors.affiliation: Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong.
authors.forename: William Wei
authors.initials: WW
authors.lastname: Sharr
authors.affiliation: Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong.
authors.forename: Chung Mau
authors.initials: CM
authors.lastname: Lo
mesh_terms: D000328:Adult; D064591:Allografts; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008099:Liver / Q000033:anatomy & histology* / Q000601:surgery; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors / Q000600:supply & distribution*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D012189:Retrospective Studies; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000592:standards*; D009927:Tissue and Organ Procurement / Q000592:standards*; D066027:Transplant Recipients; D016896:Treatment Outcome