Two types of grafts are possible for liver transplantation. Cadaveric whole liver graft(CLT) gives sufficient volume but usually considered suboptimal functionally. live donor partial liver graft(LDLT) has optimal functionally but has volume limitation. Although, the results from both type of graft are similar, but whole liver grafts are preferred then partial liver grafts if the recipient’s condition is very poor. So we analyzed the results of whole and partial liver graft transplantation which recipient's MELD score was more than 40.
From Dec. 1994 to Dec. 2016, 5241 liver transplantation were done in Asan Medical Center. 269 recipient's MELD score were more than 40. Among them, 44 cases were excluded due to salvage transplantation, multiple organ transplantation, split or two donor transplantation or retransplantation and 225 cases were analyzed. CLT were 84 cases (male 61, female 23 and mean age was 49 years). LDLT were 141 cases ( male 105, female 36 and mean age was 45 years) and 125 right lobe graft, 16 left lobe grafts were used. The GRWR( graft vs recipient weight ratio) were 2.20(1.16 -3.40) in CLT group and 0.98( 0.67 – 1.58) in LDLT group. There's no difference in MELD score in both groups ( CLT 43.4 vs LDLT 44).  In hospital mortality in CLD were 18 cases (21.4%), infection in 11, primary non function(PNF) in 2, intracranial hemorrhage(ICH)  in 3 and stress induced cardiomyopathy in 1 and sever pulmonary failure in 1 case. mortality in LDLT group were 21 cases(14.9%), infection in 11, PNF in 5, ICH in 4, and acute hepatic arterial thrombosis in 1 case. There were no difference between both group in ICU stay and post-operative hospital days and outpatient course.
In conclusion, with precise selection and careful operation, LDLT can get comparable or better results to whole liver graft transplantation.