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Article: The risk of going small: Lowering GRWR and overcoming small-for-size syndrome in adult living donor liver transplantation
|Title||The risk of going small: Lowering GRWR and overcoming small-for-size syndrome in adult living donor liver transplantation|
|Keywords||graft-to-recipient weight ratio|
living donor liver transplantation
|Publisher||Lippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com|
Annals of Surgery, 2020, Epub 2020-03-20 How to Cite?
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).
The standard GRWR in LDLT is >0.8%. Our center accepted predicted GRWR ≥0.6% in selected patients.
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%|
2019 Impact Factor: 10.13
2015 SCImago Journal Rankings: 4.503
|dc.identifier.citation||Annals of Surgery, 2020, Epub 2020-03-20||-|
|dc.description.abstract||Objective: 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.publisher||Lippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com||-|
|dc.relation.ispartof||Annals of Surgery||-|
|dc.subject||graft-to-recipient weight ratio||-|
|dc.subject||living donor liver transplantation||-|
|dc.title||The risk of going small: Lowering GRWR and overcoming small-for-size syndrome in adult living donor liver transplantation||-|
|dc.identifier.email||Wong, TCL: firstname.lastname@example.org||-|
|dc.identifier.email||Fung, JYY: jfung@HKUCC-COM.hku.hk||-|
|dc.identifier.email||She, BWH: email@example.com||-|
|dc.identifier.email||Chan, ACY: firstname.lastname@example.org||-|
|dc.identifier.email||Chok, KSH: email@example.com||-|
|dc.identifier.email||Dai, JWC: firstname.lastname@example.org||-|
|dc.identifier.email||Cheung, TT: email@example.com||-|
|dc.identifier.email||Lo, CM: firstname.lastname@example.org||-|