Living Donor in Liver Transplantation (Videos Available)

Monday July 02, 2018 from 09:45 to 11:15

Room: N-101

315.9 Excellent perioperative and long-term outcomes with lower graft-to-recipient weight ratio for living donor liver transplantation

Tiffany CL Wong, Hong Kong

Clinical assistant professor
Department of Surgery
The University of Hong Kong

Abstract

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

Tiffany Wong1, Kelvin KC Ng 1, James Yan Yue Fung2, SH chok1, TT Cheung1, ACY Chan1, WC Dai 1, CM Lo1.

1Surgery, The University of Hong Kong, Hong Kong, Hong Kong; 2Medicine, The University of Hong Kong, Hong Kong, Hong Kong

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).
Method: This 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.
Results: There 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) 
Conclusion: GRWR <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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