Abstract
AimsTo evaluate the impact of small-for-size grafts (SFSG) in adult-to-adult living donor liver transplantation (AALDLT) on outcomes of recipients with different model for end-stage liver disease (MELD) score in a single liver transplant center.Materials and MethodsClinical data of 118 patients underwent right-lobe AALDLT from January 2004 to December 2011 were retrospectively analyzed, Patients were divided into Group L (MELD score≤25) and Group H (MELD score > 25) according to MELD score. The patients were further stratified into Group LS (MELD score≤25, GBWR<0.8%), Group LN (MELD score≤25, GBWR≥0.8%), Group HS (MELD score > 25, GBWR<0.8%), and Group HN (MELD score > 25, GBWR≥0.8%) to investigate the impact of graft size on recipients’ complications and outcomes. Pre-operative characteristics, post-operative complications graded by the Clavien score and patient survival were analyzed.ResultsMELD scores between the two groups were significant different (12.4±4.9 vs 34.5±7.5, P=0.026). There was no significant difference in preoperative demographic data as well as postoperative liver function. Complication rate, length of ICU and hospital stay, graft loss, and mortality were similar in both groups. The 1- and 3- year survival were similar between group H and group L. When recipients were further stratified into group LS, LN, HS, and HN, no significant difference was found among groups in 1- and 3- year survival rate. In multivariate analysis, HCC was not a predictor for long term survival.ConclusionOur single institution experience demonstrates that it is safe to use SFSGs in high pre-MELD score recipients with the improvement of intensive care and the selection of listing criteria.
Highlights
Adult to adult living donor liver transplantation (AALDLT) has become an established procedure as a partial solution for shortage of deceased donor graft [1]
Debates still exist on the relationship between preoperative Model for End-stage Liver Disease (MELD) score and postoperative clinical outcome
Hayashi et al reported that there was no correlation between the 1-year survival rate and the preoperative MELD score [12]
Summary
Adult to adult living donor liver transplantation (AALDLT) has become an established procedure as a partial solution for shortage of deceased donor graft [1]. A partial liver graft transplanted into an adult recipient is often defined as a small-for-size graft [4]. It is generally accepted that such graft would be tolerate when the graft to body weight ratio (GBWR) is higher than 0.8%. In AALDLT, the graft size and pre-transplant MELD scores are important risk factors for patient post-transplant survival [6,7]. Outcome of recipients in a single liver transplant center with different MELD scores using a SFSG in AALDLT recipients were evaluated and discussed
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