Brief Article
Copyright ©2014 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jan 7, 2014; 20(1): 282-289
Published online Jan 7, 2014. doi: 10.3748/wjg.v20.i1.282
Outcome of patients undergoing right lobe living donor liver transplantation with small-for-size grafts
Pei-Xian Chen, Lu-Nan Yan, Wen-Tao Wang
Pei-Xian Chen, Lu-Nan Yan, Wen-Tao Wang, Department of Liver and Vascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Chen PX, Yan LN and Wang WT designed the study, performed the literature search and analyzed the data; Yan LN interpreted the results; Chen PX wrote the paper.
Supported by National Science and Technology Major Project of China, No. 2008ZX10002-025 and No. 2008ZX10002-026
Correspondence to: Lu-Nan Yan, PhD, Department of Liver and Vascular Surgery, West China Hospital of Sichuan University, No. 37 Guoxuexiang, Wuhou District, Chengdu 610041, Sichuan Province, China. cpxcsugreat@gmail.com
Telephone: +86-28-85422867 Fax: +86-28-85422469
Received: August 12, 2013
Revised: October 6, 2013
Accepted: November 1, 2013
Published online: January 7, 2014
Abstract

AIM: To investigate the outcome of living donor liver transplantation (LDLT) recipients transplanted with small-for-size grafts (SFSGs).

METHODS: Between November 2001 and December 2010, 196 patients underwent LDLT with right lobe liver grafts at our center. Recipients were divided into 2 treatment groups: group A with an actuarial graft-to-recipient weight ratio (aGRWR) < 0.8% (n = 45) and group B with an aGRWR ≥ 0.8% (n = 151). We evaluated serum liver function markers within 4 wk after transplantation. We also retrospectively evaluated the outcomes of these patients for potential effects related to the recipients, the donors and the transplantation procedures based upon a review of their medical records.

RESULTS: Small-for-size syndrome (SFSS) developed in 7 of 45 patients (15.56%) in group A and 9 of 151 patients (5.96%) in group B (P = 0.080). The levels of alanine aminotransferase and aspartate aminotransferase in group A were higher than those in group B during early period after transplantation, albeit not significantly. The cumulative 1-, 3- and 5-year liver graft survival rates were 82.22%, 71.11% and 71.11% for group A and 81.46%, 76.82%, and 75.50% for group B patients, respectively (P = 0.623). However, univariate analysis of risk factors associated with graft survival in group A demonstrated that the occurrence of SFSS after LDLT was the only significant risk factor affecting graft survival (P < 0.001). Furthermore, multivariate analysis of our data did not identify any additional significant risk factors accounting for poor graft survival.

CONCLUSION: Our study suggests that LDLT recipients with an aGRWR < 0.8% may have liver graft outcomes comparable to those who received larger size grafts. Further studies are required to ascertain the safety of using SFSGs.

Keywords: Living donor liver transplantation, Right lobe, Actuarial graft-to-recipient weight ratio, Small-for-size graft, Small-for-size syndrome

Core tip: The relative size of a liver graft is a determinant factor for successful adult-to-adult living donor liver transplantation. However, the long-term outcome and the risk factors associated with poor graft survival in recipients undergoing right lobe living donor liver transplantation using small-for-size grafts are poorly understood. In the present study, we compared the short-term and long-term outcomes of living donor liver transplantation recipients with an actuarial graft-to-recipient weight ratio < 0.8% or ≥ 0.8% and analyzed potential risk factors associated with liver graft survival when small-for-size grafts were utilized.