Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2019; 25(36): 5559-5568
Published online Sep 28, 2019. doi: 10.3748/wjg.v25.i36.5559
Impact of small-for-size liver grafts on medium-term and long-term graft survival in living donor liver transplantation: A meta-analysis
Ka Wing Ma, Kelly Hiu Ching Wong, Albert Chi Yan Chan, Tan To Cheung, Wing Chiu Dai, James Yan Yue Fung, Wong Hoi She, Chung Mau Lo, Kenneth Siu Ho Chok
Ka Wing Ma, Wing Chiu Dai, Wong Hoi She, Department of Surgery, Queen Mary Hospital, Hong Kong, China
Kelly Hiu Ching Wong, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
Albert Chi Yan Chan, Tan To Cheung, Chung Mau Lo, Kenneth Siu Ho Chok, Department of Surgery, The University of Hong Kong, Hong Kong, China
James Yan Yue Fung, Department of Medicine, Queen Mary Hospital, Hong Kong, China
Author contributions: Ma KW, Chan ACY, Cheung TT, Fung JYY, Dai WC, and She WH contributed to study design; Ma KW contributed to manuscript writing and data analysis; Ma KW and Wong KHC contributed to the paper search; Chan ACY, Cheung TT, Fung JYY, Dai WC, and She WH contributed to proofreading; Lo CM is a senior author and conceptualized the research project; Chok KSH is the corresponding author and supervised the research project.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kenneth Siu Ho Chok, FRCS (Ed), Associate Professor, Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China. chok6275@hku.hk
Telephone: +852-22553025 Fax: +852-28165284
Received: May 15, 2019
Peer-review started: May 15, 2019
First decision: June 16, 2019
Revised: June 27, 2019
Accepted: August 7, 2019
Article in press: August 7, 2019
Published online: September 28, 2019
Processing time: 137 Days and 0.7 Hours
Abstract
BACKGROUND

Small-for-size grafts (SFSGs) in living donor liver transplantation (LDLT) could optimize donor postoperative outcomes and also expand the potential donor pool. Evidence on whether SFSGs would affect medium-term and long-term recipient graft survival is lacking.

AIM

To evaluate the impact of small-for-size liver grafts on medium-term and long-term graft survival in adult to adult LDLT.

METHODS

A systematic review and meta-analysis were performed by searching eligible studies published before January 24, 2019 on PubMed, EMBASE, and Web of Science databases. The primary outcomes were 3-year and 5-year graft survival. Incidence of small-for-size syndrome and short term mortality were also extracted.

RESULTS

This meta-analysis is reported according to the guidelines of the PRISMA 2009 Statement. Seven retrospective observational studies with a total of 1821 LDLT recipients were included in the meta-analysis. SFSG is associated with significantly poorer medium-term graft survival. The pooled odds ratio for 3-year graft survival was 1.58 [95% confidence interval 1.10-2.29, P = 0.014]. On the other hand, pooled results of the studies showed that SFSG had no significant discriminatory effect on 5-year graft survival with an odds ratio of 1.31 (95% confidence interval 0.87-1.97, P = 0.199). Furthermore, incidence of small-for-size syndrome detected in recipients of SFSG ranged from 0-11.4% in the included studies.

CONCLUSION

SFSG is associated with inferior medium-term but not long-term graft survival. Comparable long-term graft survival based on liver graft size shows that smaller grafts could be accepted for LDLT with appropriate flow modulatory measures. Close follow-up for graft function is warranted within 3 years after liver transplantation.

Keywords: Living donor liver transplantation; Small-for-size grafts; Small-for-size syndrome; Graft survival

Core tip: Small-for-size grafts in living donor liver transplantation is associated with inferior medium-term but not long-term graft survival. Comparable long-term graft survival based on liver graft size shows that smaller grafts could be accepted for living donor liver transplantation with appropriate flow modulatory measures. Close follow-up for graft function is warranted within 3 years after transplantation.