Impact of Graft Weight Change During Perfusion on Hepatocellular Carcinoma Recurrence After Living Donor Liver Transplantation.

Jong Man Kim,Jinsoo Rhu,Young Jae Chung,Sangjin Kim,Gyu-Seong Choi,Jae-Won Joh

doi:10.3389/fonc.2020.609844

Jong Man Kim, Jinsoo Rhu + Show 4 more

Open Access

https://doi.org/10.3389/fonc.2020.609844

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Abstract

BackgroundsInadequate liver volume and weight is a major source of morbidity and mortality after adult living donor liver transplantation (LDLT). The purpose of our study was to investigate HCC recurrence, graft failure, and patient survival according to change in right liver graft weight after histidine-tryptophan-ketoglutarate (HTK) solution perfusion in LDLT.MethodsTwo hundred twenty-eight patients underwent LDLT between 2013 and 2017. We calculated the change in graft weight by subtracting pre-perfusion graft weight from post-perfusion graft weight. Patients with increased graft weight were defined as the positive group, and patients with decreased graft weight were defined as the negative group.ResultsAfter excluding patients who did not meet study criteria, 148 patients underwent right or extended right hepatectomy. The negative group included 89 patients (60.1%), and the positive group included 59 patients (39.9%). Median graft weight change was -28 g (range; -132–0 g) in the negative group and 21 g (range; 1–63 g) in the positive group (P<0.001). Median hospitalization time was longer for the positive group than the negative group (27 days vs. 23 days; P=0.048). There were no statistical differences in tumor characteristics, postoperative complications, early allograft dysfunction, or acute rejection between the two groups. Disease-free survival, death-censored graft survival, and patient survival were lower in the positive group than the negative group. Additionally, the positive group showed strong association with HCC recurrence, death-censored graft survival, and patient survival in multivariate analysis.ConclusionThis study suggests that positive graft weight change during HTK solution perfusion indicates poor prognosis in LDLT.

Highlights

In Asia, where there is a shortage of deceased donors, living donor liver transplantation (LDLT) is frequently performed in hepatocellular carcinoma (HCC) patients using right or left hemi-liver graft from living donors
Disease-free survival, death-censored graft survival, and patient survival were lower in the positive group than the negative group
This study suggests that positive graft weight change during HTK solution perfusion indicates poor prognosis in LDLT

Summary

Introduction

In Asia, where there is a shortage of deceased donors, living donor liver transplantation (LDLT) is frequently performed in hepatocellular carcinoma (HCC) patients using right or left hemi-liver graft from living donors. Numerous factors have been identified as predictors of short-term outcomes of LDLT such as age, model for end-stage liver disease (MELD) score, cold ischemic time, graft-to-recipient weight ratio (GRWR), transfusion demands, and laboratory test findings [1]. Histidine-Tryptophan-Ketoglutarate (HTK) solution is the only organ preservation solution used in Korea [3]. The low viscosity in HTK solution favors efficient liver graft washout because it flushes rapidly, and diffusion of preservation solution to the hepatocytes arrests hepatocellular damage. HTK solution contains histidine acting as a buffer, tryptophan as a membrane stabilizer, and ketoglutarate acting as a substrate during ischemia [4]. Because HTK solution is safe and effective, ICU stay, primary dysfunction rate, and biliary complication after liver transplantation are lower when HTK solution is used than when other preservation solutions are used [4]

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