16. Analysis of Patient Outcomes Undergoing Living Donor Liver Transplantation With Small for Size Grafts

Abstract

Background and Aims: Small for size grafts (SFSG) in adult liver transplantation carry a high morbidity and mortality. This is usually associated with living donor or split deceased donor transplantation. Traditionally, a minimum GRWR (Graft to Recipient Weight Ratio) ≥ 0.8% has been recommended. However, the lower limit of graft size for graft survival is still largely undefined. Moreover, smaller size grafts can enhance donor safety and expand donor availability in adult Living Donor Liver Transplantation (LDLT). We analyze the impact of small for size grafts on post-transplant outcome in terms of graft survival, morbidity, and mortality in adult Living Donor Liver Transplant recipients. Methods: We analyzed data from a prospectively maintained database. Patients who underwent adult LDLT in our unit between January 2011 to September 2018 were divided into 2 groups: one with GRWR ≥0.8% and the other with GRWR <0.8%. Basic demographics, preoperative factors and postoperative outcomes were analyzed and compared between the two groups. Small for size syndrome (SFSS) was defined according to standard guidelines. Results: Out of 318 LDLTs performed during the study period, 240 patients were analyzed after excluding deceased donors, dual lobe, combined liver kidney, fulminant hepatic failure and paediatric transplant recipients. 43 patients (17.9%) had GRWR < 0.8% and 197 (82.1%) had GRWR ≥ 0.8%. The mean age was 47.2 (18–66) years, with male to female ratio of 4.4:1. Among SFSGs, most were procured from left lobe (41.9% Vs 5%, p < 0.0001). SFSS was found to be more with patients with GRWR <0.8% (20.9% Vs 5.1%: p = 0.0005). The cold and warm ischaemia times were comparable in both the groups, but the an-hepatic phase was significantly lower in low GRWR group (182 Vs 219 min, p = 0.001). Both the groups were comparable in terms of postoperative ICU stay (6.6 Vs 6.4 days, p = 0.89), hospital stay (18 Vs 16.4 days, p = 0.52), graft rejection (23.2% Vs 12.7%, p = 0.07) and graft survival at 90 days (9.3% Vs 7.1%, p = 0.62). There was no significant difference in mortality between the two groups at 90 days of transplantation; rates being 11.6% Vs 8.1% (p = 0.46). No donor deaths were reported in our study. Conclusions: In our experience, though we noted higher incidence of SFSS with liver grafts of GRWR <0.8%, there was no noticeable difference in length of postoperative hospital stay, ICU stay, graft survival and mortality at 90 days. Hence we recommend that SFSG may be used to increase the donor pool in selected cases. The authors have none to declare.