Impact of Graft Size Matching on the Early Post-Transplant Complications and Patients Survival in Children after Living Donor Liver Transplantations.

Marek Stefanowicz,Marek Szymczak,Waldemar Patkowski,Grzegorz Kowalewski,Piotr Kaliciński,Hor Ismail,Krzysztof Zieniewicz,Diana Kamińska,Adam Kowalski,Ireneusz Grzelak

doi:10.3390/children8070579

Marek Stefanowicz, Marek Szymczak + Show 8 more

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https://doi.org/10.3390/children8070579

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Abstract

We aimed to assess the impact of the graft-recipient weight ratio (GRWR) on early post-transplant complications and patient survival rates in children after living donor liver transplantation (LDLT). We retrospectively analyzed 321 patients who underwent LDLT from 2004 to 2019. The recipients were categorized into four groups: 37 patients had a GRWR ≤ 1.5% (Group A), 196 patients had a GRWR > 1.5% and ≤3.5% (Group B), 73 patients had a GRWR > 3.5% and <5% (Group C) and 15 patients had a GRWR ≥ 5% (Group D). Incidence of early surgical complications including vascular complications, biliary complications, postoperative bleedings, gastrointestinal perforations and graft loss were comparable among groups with a different GRWR. Delayed abdominal wound closure was more common in patients with a GRWR > 3.5%. Recipients with a GRWR < 5% had a significantly better prognosis concerning patients and graft survival. Using grafts with a GRWR < 5% allows us to expand the donor pool and decrease the risk of mortality while on the waiting list, when patients at the time of transplantation have less advanced liver disease. LDLT with a GRWR ≥ 5% is related to a higher risk of poor outcome, and thus should be an option for treating selected patients when the risk of a delayed transplantation is high and access to deceased donors is limited.

Highlights

There are many technical variants of liver transplantation in children
We performed a retrospective analysis of 321 children after primary living donor liver transplantation was completed in our department between 1 January 2004 and 31 December 2019
Follow-up time ranged from 3 days to 17.4 years, median 7.2 years; in 240 patients

Summary

Introduction

There are many technical variants of liver transplantation in children. Selection of the method of liver transplantation depends on organ availability, urgency of surgery, the technical possibilities of transplant centers and their experience with liver surgery and organ transplantation. Since the first successful living donor liver transplantation (LDLT) in 1989 (completed by Russell Strong in Australia), the method has become an accepted treatment for children with end-stage liver failure, liver tumors and metabolic disorders [1]. A size match disparity between a liver graft and the recipient can result in complications after LDLT. The graft-to-recipient weight ratio (GRWR) is a commonly used index to predict size mismatching. The small for size graft situation is more common in adults undergoing LDLT and is defined by a GRWR < 1%

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