Excellent Perioperative and Long-Term Outcomes with Lower Graft-to-Recipient Weight Ratio for Living Donor Liver Transplantation

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Graft-to-recipient weight ratio (GRWR) ≥0.8 as threshold has been challenged and this study aimed to look at outcomes of recipients who had a lower GRWR in living donor liver transplantation (LDLT).MethodThis was a retrospective study that included all adult LDLT with recipient MELD ≤30 from 2001 to 2016. We defined GRWR <0.8% as small liver graft.ResultsThere were 367 adult LDLT with recipient MELD ≤30 within study period. Median GRWR was 0.88% (0.46-2.6). 229 patients had GRWR ≥0.8%, 138 patients had GRWR <0.8%, 29/138 (21%) had GRWR<0.6%.Median recipient age and MELD was the same. 22/138 (15.9%) in small liver graft group had MELD>25 which was the same to patients with GRWR>0.8% [46/229 (20.1%), p=0.32]. Patients who received small liver graft were more likely to be male [117/138 (84.7%) vs 146/229 (63.8%), p<0.001), had higher BMI (25.6 vs 23.2, p<0.001). 8 (5.8%) patients in small liver group vs. 3 (1.3%) in GRWR>0.8% group needed portal flow modulation (p=0.03). The recovery trend of biochemical parameters were similar in the 2 group (figure 1). There was no difference in hospital mortality (0.9 vs 0.4%, p=1.00), early complication (51.4 vs 54.6%, p=0.58), ICU stay (3 vs 3 days, p=0.21) and hospital stay (17 vs 16 days, p=0.68). 11/367 (3.0%) patients required portal flow modulation; 8 in small liver graft group and 3 in GRWR≥0.8% (p=0.03). Risk of SFSS was higher in small liver graft group (11.6 vs 0%, p<0.001). The 1- and 5-year graft survival for small liver graft group vs. GRWR≥0.8% were (94.2 vs 95.2%, 84.9 vs 85.2%, p=0.95) respectively. Patient survival was excellent with 1- and 5-year survival of 98.5 vs 95.9% and 89.1 vs 86.1% in small liver graft group vs GRWR≥0.8% (p=0.65). (Figure 2) In patients who had GRWR<0.6%, 4/29(13.8%) developed SFSS and had no hospital mortality. Graft weight did not predict recipeint hospital mortality using a cuff off at 0.8%. (Figure 3).ConclusionGRWR <0.8% can be safely used in MELD≤30 recipients without increased risk of complication, mortality and would not lead to inferior survivals.

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