Zero mortality using extreme small-for-size graft with graft-to-recipient weight ratio

Abstract

Introduction: GRWR ≥0.8% is considered the threshold in LDLT. This study evaluated outcomes with GRWR <0.6%. Methods: This was a retrospective study with all adult LDLT from 2001 to 2016. We defined GRWR <0.6% as extreme small liver graft. Outcomes of GRWR <0.6% were compared to ≥0.6%. Results: There’re 531 LDLT during study period. 35 patients had GRWR <0.6% with median graft weight 435g and median GRWR of 0.55% (0.46–0.59). GRWR ≥0.6% patients had median graft weight 597.5 g and GRWR 0.90% (0.6–2.6), p < 0.001. Median recipient age (52 vs. 52, p = 0.48), male (85.7 vs. 72.8%, p=0.11), median MELD (16.5 vs. 21, p = 0.18), MELD > 25 (28.6 vs. 44.4%, p =0.08) and HCC (45.7 vs. 34.7%, p=0.20) were the same. Patients with GRWR < 0.6% had higher BMI (27.3 vs. 24.2, p < 0.001). GRWR < 0.6% had more left lobe LDLT (28.6 vs. 4.4%, p < 0.001). More patients in GRWR< 0.6% required portal flow modulation (20 vs. 3.6%, p < 0.001), mostly splenic artery ligation/embolization. Fig. 1 showed recipients' postoperative outcomes. No hospital mortality in GRWR < 0.6%. Donor age, sex, >10% steatosis graft, hospital stay and complication were the same. Donor BMI was lower in GRWR <0.6% (19.8 vs. 21.7, p < 0.001). Patient/graft survivals were equivalent (Fig. 2). Multivariate analyses, recipient sex, BMI and HCC predicted patient survival while recipient sex, BMI and high MELD predicted graft survival; graft size didn´t predict patient/graft survival. Conclusion: GRWR< 0.6% wasn't associated with higher mortality, complication, small for size syndrome and inferior long-term outcomes.