Combination of Donor Anthropometrics With Recipient Imaging to Improve Matching in Liver Transplantation

Addeo, Pietro; Bachellier, Philippe; Noblet, Vincent

doi:10.1002/lt.26300

Cited by 5 publications

(4 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As stated by Zhou et al, 18 the specific shape of the liver graft should be evaluated during the back table as it is insufficiently described by the GRWR or RAP. However, GW/RAP ratio, used in adult LT to estimate the risk for LFS 19 was above 100 g/cm in two recipients. This suggests its utility in pediatric LT for adolescent recipients as an indicator for graft reduction (Figure 2–4).…”

Section: Discussionmentioning

confidence: 91%

Optimizing graft‐recipient size matching in adolescent liver transplantation: Don't forget ex situ right posterior sectionectomy

Rossignol

Muller

Dubois

et al. 2023

Pediatric Transplantation

View full text Add to dashboard Cite

Background Graft‐recipient size matching is a major challenge in pediatric liver transplantation, especially for adolescent recipients. Indeed, adolescents have the lowest transplantation rate among pediatric recipients, despite prioritization policies and the use of split grafts. In case of an important graft‐recipient size mismatch, ex situ graft reduction with right posterior sectionectomy (RPS) may optimize the available donor pool to benefit adolescent recipients. Methods We present three cases of liver graft reduction with ex situ RPS for adolescent recipients. The surgical strategy was guided by GRWR (graft/recipient weight ratio), GW/RAP (right anteroposterior distance ratio), and CT‐scan volumetric and anthropometric evaluation. Results Recipients were 12, 13, and 14‐year‐old and weighed 32, 47, and 35 kg, respectively. All liver grafts were procured from brain‐dead donors with a donor/recipient weight ratio >1.5. RPS was performed ex situ, removing 20% of the total liver volume leading to a decrease of the GRWR <4% and the GW/RAP <100 g/cm in each case. All three reduced grafts were successfully transplanted with a static cold storage time ranging from 390 to 510 min without the need for delayed abdominal closure. We did not observe any primary non‐function, vascular complication, or delayed graft function with a median follow‐up of 6 months. One biliary anastomotic stenosis occurred which required surgical treatment. Conclusion Ex situ liver graft reduction with RPS allowed for successful transplantation in case of anthropometric graft‐recipient size mismatch in adolescent liver transplant candidates. Although the use of split grafts remains the gold standard, RPS should be acknowledged as a way to optimize the donor pool, especially for adolescent recipients.

show abstract

Section: Discussionmentioning

confidence: 91%

Optimizing graft‐recipient size matching in adolescent liver transplantation: Don't forget ex situ right posterior sectionectomy

Rossignol

Muller

Dubois

et al. 2023

Pediatric Transplantation

View full text Add to dashboard Cite

show abstract

“…First, preprocurement imaging of the donor enables a direct measurement of graft size, which allows us to optimize matching with the anthropometric data of the recipient. [26] Second, pre-LT CTscan of the recipient allows for identifying surrogates of LPF, such as PVT, [27,28] portal vein caliber, [29] and PSS. Besides, pre-LT evaluation by CT-scan [30] or 4D-MRI [31] is a promising perspective to anticipate the surgical strategy for portal flow modulation by providing a precise anatomic and hemodynamic mapping of PSS.…”

Section: Discussionmentioning

confidence: 99%

“…Given the fact that the actual portal flow can only be measured during LT, several pre-LT indicators should be assessed to optimize graft-recipient matching to reduce the risk of LFF. First, preprocurement imaging of the donor enables a direct measurement of graft size, which allows us to optimize matching with the anthropometric data of the recipient 26 . Second, pre-LT CT-scan of the recipient allows for identifying surrogates of LPF, such as PVT, 27,28 portal vein caliber, 29 and PSS.…”

Section: Discussionmentioning

confidence: 99%

From large-for-size to large-for-flow: A paradigm shift in liver transplantation

Rossignol

Muller

Couillerot

et al. 2023

Liver Transplantation

View full text Add to dashboard Cite

Liver graft-recipient matching remains challenging, and both morphologic and hemodynamic characteristics have been shown to be relevant indicators of post-transplant outcomes. However, no combined analysis is available to date. To study the impact of both morphologic and hemodynamic characteristics of liver grafts on transplantation outcomes, we retrospectively evaluated all consecutive 257 liver transplantations with prospective hemodynamic measurements from 2017 to 2020 in a single-center perspective. First, a morphologic analysis compared recipients with or without largefor-size (LFS), defined by a graft/recipient weight ratio > 2.5% and excluding extreme LFS. Second, a hemodynamic analysis compared recipients with or without low portal flow (LPF; <80 mL/min per 100 g of liver tissue). Third, an outcome analysis combining LPF and LFS was performed, focusing on liver graft-related morbidity (LGRM), graft and patient survival. LGRM was a composite endpoint, including primary nonfunction, high-risk L-Graft7 category, and portal vein thrombosis. Morphologic analysis showed that LFS (n = 33; 12.9%) was not associated with an increased LGRM (12.1% vs 9.4%; p = 0.61) or impaired graft and patient survival. However, the hemodynamic analysis showed that LPF (n = 43; 16.8%) was associated with a higher LGRM (20.9% vs 7.5%, p = 0.007) and a significantly impaired 90-day graft and patient survival. Multivariable analysis identified LPF but not LFS as an independent risk factor for LGRM (OR: 2.8%; CI:1.088-7.413; and p = 0.03), 90-day (HR: 4%; CI: 1.411-11.551; and p = 0 .01), and 1-year patient survival. LPF is a significant predictor of post-liver transplantation morbimortality, independent of LFS when defined as a morphologic metric alone.

show abstract

“…Based on our experience and others, the size discrepancy between the anteroposterior dimensions of the graft and the longest RAP of the recipient should still be considered a first-line index for evaluating the occurrence of the LFSS. Thus, the choice of the liver segments to be resected should be based on the combination of the anthropometrics of the donor graft with that of the recipient ( 1 , 5 ). The anteroposterior dimension of the graft can be accurately measured on the back table to provide a precise parameter for determining the necessity of right posterior sectionectomy.…”

mentioning

confidence: 99%

Adopting Individualized Strategies to Prevent Large-For-Size Syndrome in Adult Liver Transplant Recipients: The Graft Morphology Should Also Be Taken Into Account

Zhou¹,

Lin²,

Zhu³

2022

Transpl Int

View full text Add to dashboard Cite

Combination of Donor Anthropometrics With Recipient Imaging to Improve Matching in Liver Transplantation

Cited by 5 publications

References 4 publications

Optimizing graft‐recipient size matching in adolescent liver transplantation: Don't forget ex situ right posterior sectionectomy

Optimizing graft‐recipient size matching in adolescent liver transplantation: Don't forget ex situ right posterior sectionectomy

From large-for-size to large-for-flow: A paradigm shift in liver transplantation

Adopting Individualized Strategies to Prevent Large-For-Size Syndrome in Adult Liver Transplant Recipients: The Graft Morphology Should Also Be Taken Into Account

Contact Info

Product

Resources

About