Older donor age is the risk factor for negative outcomes after adult living donor liver transplantation using small-for-size grafts

Abstract

Introduction: Adult-to-adult living donor liver transplantation (ALDLT) using small for size grafts (SFSGs) (graft-to-recipient weight ratio (GRWR) < 0.8%) has been a challenge that should be carefully dealt with and risk factors in this category are unclear. Method: We aimed to examine the risk factors and outcomes of ALDLT using SFSGs in 121 patients who had undergone their first ALDLT using SFSGs over a 13-year-period. Result: Small-for-size syndrome (SFSS), early graft loss and 1-year mortality were encountered in 21.6%, 15.1% and 18.4% of patients, respectively. By multivariate analysis, older donor age (≥ 45 years) was an independent risk factor for SFSS, with early graft loss and 1-year mortality P values of 0.004, 0.02 and 0.02 and odds ratios (OR) of 4.46, 4.11 and 3.76, respectively. Child-Pugh C-class recipients were associated with a higher risk of SFSS development (P=0.013, OR 7.44). Despite no significant difference between GRWR% categories in the multivariate outcome analysis of the whole population, in the survival analysis of the two donor age groups, GRWR < 0.6% was associated with significantly lower 1-year survival than the other GRWR% categories in the younger donor group. Moreover, in the high final portal venous pressure (PVP) group (> 15 mmHg), younger ABO compatible donors showed 100% 1-year survival with a significant difference from the group of other donors. Conclusion: Older donor age was an independent risk factor for SFSS, early graft loss and 1-year mortality after ALDLT using SFSGs. GRWR should not be lower than 0.6% and PVP modulation is indicated when grafts from older or ABO incompatible donors are used.