Copyright
©The Author(s) 2018.
World J Gastroenterol. Jun 21, 2018; 24(23): 2441-2456
Published online Jun 21, 2018. doi: 10.3748/wjg.v24.i23.2441
Published online Jun 21, 2018. doi: 10.3748/wjg.v24.i23.2441
Table 1 Recommended minimum graft-to-recipient weight ratio in different studies
| Ref. | Recommended minimum GRWR | n (small vs large) | One-year survival (small vs large) | Five-year survival (small vs large) | Study type |
| Kiuchi et al[10] (1999) | 1% | 276 (49 vs 215) | 61.2% vs 92.6% | NS | RS |
| Lee et al[11] (2003) | 0.8% | 141 (10 vs 131) | Univariate and multiple analysis | NS | RS |
| Moon et al[13] (2010) | Less than 0.8% | 427 (35 vs 392) | 87.8% vs 90.7% | 74.1% vs 79.4% | RS |
| Lan et al[14] (2009) | Less than 0.8% | 89 (15 vs 74) | 73.3% vs 71.6% | NS | RS |
| Selzner et al[15] (2009) | Less than 0.8% | 271 (22 vs 249) | 91.0% vs 89.0% | 83.0% vs 87% | RS |
| Chen et al[16] (2014) | Less than 0.8% | 196 (45 vs 151) | 82.2% vs 81.4% | 71.1% vs 75.5% | RS |
| She et al[17] (2017) | Left lobe graft vs right lobe graft | 218 (19 vs 199) | 89.5% vs 95.9% | 89.5% vs 86.8% | RS |
| Lee et al[18] (2014) | Less than 0.7% | 317 (23 vs 294) | 100% vs 93.2% | NS | RS |
| Alim et al[19] (2016) | 0.6% | 649 | Seven patients had GRWR of 0.6%. If MELD score was below 20, donor age below 45, and no signs for any hepatosteatosis, GRWR of 0.6% was safe | RS | |
| Lee et al[20] (2015) | 0.40% | NS | Lowest GRWR of 0.40% had been successfully used | RS | |
Table 2 Incidence of small-for-size syndrome when using small-for-size grafts n (%)
| Ref. | n | SFSS (Incidence) | Factors to SFSS | Study type |
| Goldaracena et al[21] (2017) | NS | NS | A graft GRWR < 0.8% of predisposes the graft to SFSS | RE |
| Graham et al[22] (2014) | NS | NS | GRWR of 0.8 to 1.0 was established as a lower limit to prevent SFSS | RE |
| Botha et al[23] (2010) | 21 | 1 (4.7) | Hemi-portocaval shunt can decrease SFSS incidence | RS |
| Goralczyk et al[24] (2011) | 22 | 5 (22.7) | Posterior cavoplasty can decrease SFSS incidence | RS |
| Soejima et al[25] (2003) | 36 | 8 (22.2) | Cirrhosis predisposes the graft to SFSS | RS |
| Ben-Haim et al[26] (2001) | 40 | 5 (8) | Child’s class B or C with received grafts of GRWR < 0.85% predisposes the graft to SFSS | RS |
| Sudhindran et al[27] (2012) | NS | 10%-20% | Left lobe grafts predisposes the graft to SFSS | RE |
| Yi et al[28] (2008) | 29 | 8 (27.5) | Left lobe grafts predisposes the graft to SFSS | RS |
| Soejima et al[29] (2012) | 312 | 43 (15.3) | Left lobe grafts predisposes the graft to SFSS | RS |
| Gruttadauria et al[30] (2015) | 83 | 13 (15.7) | Non-surgical modulation of the portal inflow can decrease SFSS incidence | RS |
| Shoreem et al[31] (2017) | 174 | 20 (11.5) | Left lobe grafts predisposes the graft to SFSS | RS |
| Lauro et al[32] (2007) | 8 | 4 (50) | Surgical modulation of the portal inflow can decrease SFSS incidence | RS |
Table 3 Remedies when using small-for-size graft
| Ref. | n | Remedy for using small-for-size graft | Study type |
| Botha et al[23] (2010) | 21 | Hemi-portocaval shunt can decrease SFSS incidence | RS |
| Goralczyk et al[24] (2011) | 22 | Posterior cavoplasty can decrease SFSS incidence | RS |
| Kim et al[47] (2017) | 160 | Preserving collateral veins on small-for-size grafts | RS + PSM |
| Hessheimer et al[48] (2011) | NS | Portocaval shunt | AE |
| Xiao et al[49] (2012) | 1 | Transjugular intrahepatic portosystemic shunt | CR |
| Sato et al[50] (2008) | 4 | Portocaval shunt using ligamentum teres | CR |
| Nutu et al[51] (2018) | 2 | Complete splenic embolization | CR |
| Badawy et al[52] (2017) | 164 | Splenectomy | RS |
| Troisi et al[53] (2016) | NS | Splenic artery ligation, splenectomy, meso-caval shunt, spleno-renal shunt, portocaval shunt, and splenic artery embolization | SR |
| Xu et al[54] (2015) | NS | Dual grafts | RE |
| Gao et al[55] (2017) | NS | Adipose-derived mesenchymal stem cells tranplantation | AE |
| Kobayashi et al[56] (2009) | 5 | Auxiliary partial liver transplantation | CR |
Table 4 Older donors for living donor liver transplantation
| Ref. | Definition of older donors | n (older vs young) | One-year survival (older vs young) | Five-year survival (older vs young) | Study type |
| Tanemura et al[58] (2012) | 50 yr old | 101 (24 vs 77) | Older donor livers might have impaired regenerative ability | RS | |
| Ono et al[60] (2011) | 50 yr old | 15 (6 vs 9) | Liver regeneration is impaired with age after donor hepatectomy | RS | |
| Akamatsu et al[61] (2007) | 50 yr old | 299 (62 vs 237) | 85.0% vs 93.0% | 72.0% vs 87.0% | RS |
| Kawano et al[62] (2014) | NS | 12 | Donor age is a crucial factor affecting telomere length sustainability in hepatocytes after pediatric LDLT | PS | |
| Imamura et al[63] (2017) | NS | 198 | A worse outcome might be associated with aging of the donor | RS | |
| Dayangac et al[64] (2011) | 50 yr old | 150 (28 vs 122) | 78.6% vs 83.4% | NS | RS |
| Yoshizumi et al[65] (2008) | NS | 28 | Graft size, donor age, and patient status are the indicators of early graft function | RS | |
| Han et al[66] (2014) | 55 yr old | 604 (26 vs 578) | Median OS (M): 31.2 ± 31.3 vs 50.6 ± 40.6 | RS | |
| Kamo et al[67] (2015) | 60 yr old | 1597 (69 vs 1528) | 69.5% vs 81.2% | 62.0% vs 79.3% | RS |
| Shin et al[68] (2013) | Donor-recipient age gradient > 20 | 821 | Worse graft survival was observed if the donor is older than the recipient by > 20 | RS | |
| Kubota et al[69] (2017) | 50 yr old | 315 (126vs 189) | 73.0% vs 80.9% | 39.7% vs 47.1% | RS |
| Katsuragawa et al[70] | NS | 24 | G/SLV and donor age were independent factors that affected graft survival rates | RS | |
| Wang et al[72] (2015) | 50 yr old | 159 (10 vs 149) | 100% vs 93.0% | 90.0% vs 87.0% | RS |
| Ikegami et al[73] (2008) | 50 yr old | 232 (32 vs 200) | 80.0% vs 81.7% | 73.8% vs 76.7% | RS |
| Li et al[74] (2012) | 50 yr old | 129 (21 vs 108) | 90.0% vs 86.0% | 66.0% vs 75% | RS |
| Goldaracena et al[75] (2016) | 50 yr old | 469 (91 vs 378) | 92.0% vs 96.0% | 83.0% vs 79.0% | RS |
| Kim et al[76] (2017) | 55 yr old | 540 (42 vs 498) | 95.2% vs 94.6% | NS | RS |
Table 5 Impact of ABO-incompatible on living donor liver transplantation
| Ref. | n | Complications | Incidence of related complication (%) | Risk factors | Study type |
| Miyata et al[80] (2007) | 57 | Thrombotic microangiopathy | 7.0 | ABO-incompatibility, CPA, and recipient blood group (type O) | RS |
| Oya et al[81] (2008) | 1 | Thrombotic microangiopathy | NS | ABO-incompatible LDLT (type B to O) | CR |
| Kishida et al[82] (2016) | 129 | Thrombotic microangiopathy | 10.1 | ABO-incompatible, tacrolimus | RS |
| Song et al[83] (2014) | 1102 | Biliary stricture | 15.8 | ABO-incompatible, acute cellular rejection | RS |
| Ikegami et al[84] (2016) | 408 | Biliary stricture | 20.4 | ABO-incompatible | RS |
| Yamada et al[88] (2010) | 1 | Idiopathic hypereosinophilic | NS | ABO-incompatible | CR |
Table 6 Remedies when using ABO- incompatible on living donor liver transplantation
| Ref. | n | Immunosuppression strategy | Remedies | Conclusion | Study type |
| Kawagishi et al[89] (2009) | 105 | TAC + MP + AZ | Rituximab | ABO-incompatible LDLT can be feasible used if humoral rejection are overcome | RS |
| Yoon et al[90] (2018) | 918 | TAC + MP + steroids | Rituximab and PE | ABO-incompatible LDLT is a feasible option under remedies | RS |
| Sakai et al[91] (2017) | 20 | TAC+ MP | Rituximab and PE | FCGR SNPs influence the effect of rituximab on B-cells | PS |
| Egawa et al[92] (2017) | 33 | TAC | Rituximab, PE, local infusion, splenectomy and immunoglobulins | Only rituximab dose is a significantly favorable factor for AMR | RS |
| Ikegami et al[93] (2007) | 1 | TAC + MP + steroids | Rituximab and PE | Rituximab and plasma exchanges seemed ineffective | CR |
| Ikegami et al[94] (2009) | 7 | TAC + MP + steroids | Rituximab, IVIG, and PE | Rituximab, IVIG, and PE seems to be a safe treatment | RS |
| Usui et al[95] (2007) | 73 | TAC + MP + steroids | Rituximab, PE and splenectomy | Bone suppression is a big challenge when using rituximab | RS |
| Chen et al[96] (2017) | 2 | TAC + MP + steroids | Basiliximab combine with splenectomy | ABO-i LDLT with splenectomy is undoubtedly life-saving | CR |
| Uchiyama et al[97] (2011) | 15 | TAC + MP + steroids | Rituximab and PE | Isoagglutinin mediated-rejection should be more concerned | RS |
| Soin et al[98] (2014) | 3 | TAC + MP + steroids | Rituximab and PE | ABO-incompatible LDLT is a feasible option under remedies | CR |
| Rummler et al[99] (2017) | 10 | TAC + MP + steroids | PE | Immunosuppression only combining with PE is feasible | RS |
| Kim et al[100] (2016) | 182 | TAC + MP + steroids | Rituximab, IVIG, and PE | ABO-incompatible LDLT can be safely performed under remedies | RS |
| Kim et al[101] (2013) | 22 | TAC + MP + steroids | Rituximab and PE | ABO-incompatible LDLT can be safely performed under remedies | RS |
| Kawagishi et al[102] (2005) | 3 | TAC + MP + steroids | Rituximab and PE | ABO-incompatible LDLT can be safely performed under remedies | CR |
| Kim et al[103] (2017) | 43 | TAC + MP + steroids | Rituximab and IVIG | A simplified protocol using rituximab and IVIG for ABO-I LDLT is safe | RS |
| Yoshizawa et al[104] (2005) | 8 | TAC + MP + cyclophosphamide | Rituximab and PGE1 infusion | Rituximab prophylaxis and HA infusion therapy is feasible | RS |
| Egawa et al[105] (2008) | 118 | TAC + steroids | Methylprednisolone and PGE1 infusion | Recipients with preexisting high effector CD8 T- cells are unfavorable candidates for ABO-I LDLT | RS |
| Yamamoto et al[106] (2018) | 40 | TAC + MP + steroids | Rituximab monotherapy | Rituximab monotherapy is feasible | RS |
Table 7 Impact of graft steatosis on living donor liver transplantation
| Ref. | n | Conclusion | Study type |
| Dirican et al[9] (2015) | 161 | Approximately 40% of donor grafts are discarded because of severe liver steatosis | RS |
| Perkins et al[109] (2006) | NS | Typically steatotic livers with > 60% fat are not transplanted; with < 30% fat are usable and anticipated to have good function; with 30%-60% fat give poor results | Comments |
| Kotecha et al[110] (2013) | 340 | Hepatic steatosis is a leading cause of donor rejection in LDLT | PS |
| Cho et a[111]l (2010) | 54 | Hepatocyte replication is impaired during steatotic liver regeneration after LDLT | PS |
| Cho et al[112] (2006) | 67 | Hepatic steatosis is associated with intrahepatic cholestasis and transient hyperbilirubinemia during regeneration | PS |
| Cho et al[113] (2005) | 55 | Mildly steatotic graft did not increase the risk of graft dysfunction or morbidity in LDLT | PS |
| Gao et al[114] (2009) | 24 | Moderately steatotic (30%-60%) liver grafts provide adequate function in the first phase after transplantation and can be used for transplantation | RS |
| Knaak et al[115] (2017) | 105 | Donors with BMI > 30, in the absence of graft steatosis, are not contraindicated for LDLT | RS |
| Han et al[116] (2015) | 211 | The risk of steatosis may be determined by the relative composition of MiS and MaS, rather than the total quantitative degree | RS |
Table 8 Treatments for fat donors
| Ref. | n | Treatments | Study type |
| Oshita et al[117] (2012) | 128 | Diet treatment consisting of an 800 to 1400 kcal/d diet and a 100 to 400 kcal/d exercise regimen without drug treatment, targeting body mass index of 22 kg/m² | RS |
| Nakamuta et al[118] (2013) | 11 | Bezafibrate (400 mg/d) was used along with a protein-rich (1000 kcal/d) diet and exercise (600 kcal/d) for 2-8 wk | RS |
| Choudhary et al[119] (2015) | 16 | 1200 kcal/d and a minimum of 60 min/d of moderate cardio training are also recommended to rapidly reverse liver steatosis in donors | PS |
| Moon et al[120] (2006) | 2 | Dual-graft living donor liver transplantation for severe graft steatosis | CR |
Table 9 Impact of HBsAg or HBcAb(+) grafts on HBsAg(-) living donor liver transplantation patients
| Ref. | Donor | Incidence of de novo HBV infection (%) | Prevention of de novo HBV infection | Study type |
| Wang[121] (2017) | HBcAb(+) | 4.2 | HBV vaccinations with the aim of achieving anti-HBs > 1000 IU/L pre-transplant and > 100 IU/L post-transplant | RS |
| Xi et al[122] (2013) | HBcAb(+) | 23.9 | No prophylaxis, adefovir, and lamivudine are given to de novo patients | RS |
| Dong et al[123] (2017) | HBcAb(+) | 7.9 | HBIG 100 IU/kg during the operation and lamivudine 3 mg/kg per day after the surgery for at least 1 year until HBV vaccine reaction | RS |
| Loggi et al[124] (2016) | HBsAg(+) | NS | HBIG and lamivudine, adefovir or tenofovir | SR |
| Lei et al[125] (2013) | HBcAb(+) | 15.0 | No specific prophylaxis | RS |
| Lin et al[126] (2007) | HBcAb(+) | 3.3 | Lamivudine monoprophylaxis, HBV vaccinations | RS |
| Hara et al[127] (2016) | HBcAb(+) | NS | Lamivudine first and adefovir dipivoxil were combined with lamivudine 2 yr later | CR |
Table 10 Impact of HBsAg or HBcAb(+) grafts on HBsAg(+) living donor liver transplantation patients
| Ref. | Donor | Incidence of de novo HBV infection | Prevention of De Novo HBV infection | Study type |
| Hwang et al[129] (2006) | HBsAg(+) | NS | High-dose HBIG and lamivudine, famciclovir and interferon; a final regimen of lamivudine and adefovir | CR |
| Soejima et al[130] (2007) | HBsAg(+) | NS | lamivudine and adefovir dipivoxil | CR |
| Jeng et al[131] (2015) | HBsAg(+) | NS | Entecavir 0.5 mg once daily | RS |
Table 11 Graft with hepatic benign tumor
| Ref. | n | Type of tumors in grafts | Prognosis | Study type |
| Li et al[133] (2017) | 15 | Cavernous hemangioma, perivascular epithelioid cell tumor, inflammatory pseudotumor, and focal nodular hyperplasia | One patient died from pulmonary embolism | OS |
| Fuchino et al[134] (2017) | 1 | HBsAg(+) and inflammatory pseudotumor | Tumor vanished after 3 yr | CR |
- Citation: Lan X, Zhang H, Li HY, Chen KF, Liu F, Wei YG, Li B. Feasibility of using marginal liver grafts in living donor liver transplantation. World J Gastroenterol 2018; 24(23): 2441-2456
- URL: https://www.wjgnet.com/1007-9327/full/v24/i23/2441.htm
- DOI: https://dx.doi.org/10.3748/wjg.v24.i23.2441