A retrospective study investigating the risk of graft loss in living donor liver transplant cases where size mismatching is predicted from graft-to-recipient weight ratio
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In brief
In brief
This retrospective study examines outcomes in 99 pediatric living donor liver transplant patients across different graft-to-recipient weight ratios. Intraoperative adjustments like splenectomy and delayed abdominal closure enabled safe expansion beyond traditional GRWR thresholds without compromising 5-year survival or increasing thrombosis risk.
- GRWR outside 0.8-3.5% range can be safely managed with intraoperative adjustments like splenectomy and delayed abdominal closure.
- No significant difference in 5-year patient/graft survival or thrombosis rates when GRWR criteria expanded beyond traditional thresholds.
- 46% of size-mismatched cases required splenectomy or delayed closure to optimize portal flow and accommodate graft size.
- Traditional GRWR criteria may be safely expanded in pediatric LDLT when appropriate surgical modifications are employed.
- Portal flow modulation and abdominal wall management are key strategies for mitigating size mismatch complications in LDLT.
Written by the GCMD Library team from the article.
Abstract
Background/purpose
Living donor liver transplantation (LDLT) is vital for pediatric end-stage liver disease due to organ shortages. The graft-to-recipient weight ratio (GRWR) preoperatively measured predicts the outcomes of LDLT. We typically target between 0.8 and 3.0–4.0%, but the ideal GRWR remains controversial. We compared the outcomes of LDLT according to the GRWR to examine whether the criteria could be expanded while ensuring safety.
Methods
We retrospectively reviewed 99 patients who underwent LDLT in our department by dividing them into three groups according to their GRWR: Group S, with GRWR values lower than the normal range (GRWR < 0.8%); Group M, with GRWR values in the normal range (GRWR ≥ 0.8 to < 3.5%); and Group L, with GRWR values above the normal range (GRWR ≥ 3.5%).
Results
In Groups S and L, 46.2 and 44.4% of patients underwent splenectomy and delayed abdominal wall closure, respectively. After these intraoperative adjustments, there were no significant differences between the groups in 5-year patient survival, 5-year graft survival, or the occurrence of post-transplantation thrombosis.
Conclusion
When the GRWR is beyond the normal threshold, the risk of complications associated with graft size might be reduced by adjustments to provide appropriate portal blood flow and by delayed abdominal wall closure.