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Article: The risk of going small: Lowering GRWR and overcoming small-for-size syndrome in adult living donor liver transplantation

TitleThe risk of going small: Lowering GRWR and overcoming small-for-size syndrome in adult living donor liver transplantation
Authors
Keywordsgraft-to-recipient weight ratio
living donor liver transplantation
small-for-size syndrome
survival outcomes
Issue Date2020
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com
Citation
Annals of Surgery, 2020, Epub 2020-03-20 How to Cite?
AbstractObjective: The aim of this study was to determine the outcomes of living donor liver transplantation (LDLT) according to various graft-to-recipient weight ratio (GRWR). Background: The standard GRWR in LDLT is >0.8%. Our center accepted predicted GRWR ≥0.6% in selected patients. Methods: Data from patients who underwent LDLT from 2001 to 2017 were included. Patients were stratified according to actual GRWR (Group 1:GRWR ≤0.6%; Group 2: 0.6%0.8%). Results: There were 545 LDLT (group 1 = 39; group 2 = 159; group 3 = 347) performed. Pretransplant predicted GRWR showed good correlation to actual GRWR (R2 = 0.834) and these figures differed within a ± 10%margin (P = 0.034) using an equivalence test. There were more left lobe grafts in group 1 (33.3%) than group 2 (10.7%) and 3 (2.9%). Median donor age was <35 years and steatosis >10% was rare. There was no difference in postoperative complication, vascular and biliary complication rate between groups. Over one-fifth (20.5%) of group 1 patients required portal flow modulation (PFM) and was higher than group 2 (3.1%) and group 3 (4%) (P = 0.001). Twenty-six patients developed small-for-size syndrome (SFSS): 5 of 39 (12.8%) in group 1 and 21 of 159 (13.2%) in group 2 and none in group 3 (P < 0.001). There were 2 hospital mortalities; otherwise, the remaining patients [24/26 (92.3%)] survive with a functional liver graft. The 5-year graft survival rates were 85.4% versus 87.8% versus 84.7% for group 1, 2, and 3, respectively (P = 0.718). GRWR did not predict worse survivals in multivariable analysis. Conclusions: Graft size in LDLT can be lowered to 0.6% after careful recipient selection, with low incidence of SFSS and excellent outcomes. Accurate graft weight prediction, donor-recipient matching, meticulous surgical techniques, appropriate use of PFM, and vigilant perioperative care is important to the success of such approach.
Persistent Identifierhttp://hdl.handle.net/10722/285296
ISSN
2019 Impact Factor: 10.13
2015 SCImago Journal Rankings: 4.503

 

DC FieldValueLanguage
dc.contributor.authorWong, TCL-
dc.contributor.authorFung, JYY-
dc.contributor.authorCui, TYS-
dc.contributor.authorSin, SL-
dc.contributor.authorMa, KW-
dc.contributor.authorShe, BWH-
dc.contributor.authorChan, ACY-
dc.contributor.authorChok, KSH-
dc.contributor.authorDai, JWC-
dc.contributor.authorCheung, TT-
dc.contributor.authorLo, CM-
dc.date.accessioned2020-08-18T03:52:08Z-
dc.date.available2020-08-18T03:52:08Z-
dc.date.issued2020-
dc.identifier.citationAnnals of Surgery, 2020, Epub 2020-03-20-
dc.identifier.issn0003-4932-
dc.identifier.urihttp://hdl.handle.net/10722/285296-
dc.description.abstractObjective: The aim of this study was to determine the outcomes of living donor liver transplantation (LDLT) according to various graft-to-recipient weight ratio (GRWR). Background: The standard GRWR in LDLT is >0.8%. Our center accepted predicted GRWR ≥0.6% in selected patients. Methods: Data from patients who underwent LDLT from 2001 to 2017 were included. Patients were stratified according to actual GRWR (Group 1:GRWR ≤0.6%; Group 2: 0.6%<GRWR≤ 0.8%; Group 3:GRWR >0.8%). Results: There were 545 LDLT (group 1 = 39; group 2 = 159; group 3 = 347) performed. Pretransplant predicted GRWR showed good correlation to actual GRWR (R2 = 0.834) and these figures differed within a ± 10%margin (P = 0.034) using an equivalence test. There were more left lobe grafts in group 1 (33.3%) than group 2 (10.7%) and 3 (2.9%). Median donor age was <35 years and steatosis >10% was rare. There was no difference in postoperative complication, vascular and biliary complication rate between groups. Over one-fifth (20.5%) of group 1 patients required portal flow modulation (PFM) and was higher than group 2 (3.1%) and group 3 (4%) (P = 0.001). Twenty-six patients developed small-for-size syndrome (SFSS): 5 of 39 (12.8%) in group 1 and 21 of 159 (13.2%) in group 2 and none in group 3 (P < 0.001). There were 2 hospital mortalities; otherwise, the remaining patients [24/26 (92.3%)] survive with a functional liver graft. The 5-year graft survival rates were 85.4% versus 87.8% versus 84.7% for group 1, 2, and 3, respectively (P = 0.718). GRWR did not predict worse survivals in multivariable analysis. Conclusions: Graft size in LDLT can be lowered to 0.6% after careful recipient selection, with low incidence of SFSS and excellent outcomes. Accurate graft weight prediction, donor-recipient matching, meticulous surgical techniques, appropriate use of PFM, and vigilant perioperative care is important to the success of such approach.-
dc.languageeng-
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com-
dc.relation.ispartofAnnals of Surgery-
dc.subjectgraft-to-recipient weight ratio-
dc.subjectliving donor liver transplantation-
dc.subjectsmall-for-size syndrome-
dc.subjectsurvival outcomes-
dc.titleThe risk of going small: Lowering GRWR and overcoming small-for-size syndrome in adult living donor liver transplantation-
dc.typeArticle-
dc.identifier.emailWong, TCL: wongtcl@hku.hk-
dc.identifier.emailFung, JYY: jfung@HKUCC-COM.hku.hk-
dc.identifier.emailShe, BWH: brianshe@hku.hk-
dc.identifier.emailChan, ACY: acchan@hku.hk-
dc.identifier.emailChok, KSH: chok6275@hku.hk-
dc.identifier.emailDai, JWC: daiwc@hku.hk-
dc.identifier.emailCheung, TT: cheung68@hku.hk-
dc.identifier.emailLo, CM: chungmlo@hkucc.hku.hk-
dc.identifier.authorityWong, TCL=rp01679-
dc.identifier.authorityFung, JYY=rp00518-
dc.identifier.authorityChan, ACY=rp00310-
dc.identifier.authorityChok, KSH=rp02110-
dc.identifier.authorityCheung, TT=rp02129-
dc.identifier.authorityLo, CM=rp00412-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1097/SLA.0000000000003824-
dc.identifier.pmid32209906-
dc.identifier.hkuros312944-
dc.identifier.volumeEpub 2020-03-20-
dc.publisher.placeUnited States-

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