Disadvantage of Small (<60 kg) Adult Candidates on the Liver Transplantation Waitlist

Abstract

Background: Small adult patients with lower bodyweight wait-listed for liver transplantation may face a shortage of size-matched whole-liver grafts. The objective of this study is to compare time to transplantation in adult patients with a bodyweight of &lt;60 kg to patients with bodyweight ≥60 kg. Methods: A matched case–control study was conducted. Patients aged 18 years and older listed for liver transplantation at our transplant center, from 2007 to 2016 with a bodyweight &lt;60 kg were manually matched 1:2 to control patients ≥ 60 kg. Matching was performed based on ABO blood type, model for end-stage liver disease score, (non)-standard exception status, and eligibility for donation after cardiac death. Time to transplantation was assessed with univariable Cox-regression. Results: In total, 23 cases with a bodyweight &lt; 60 kg were matched to 46 average-sized control patients. Small adults were significantly disadvantaged for receiving a liver transplantation as compared to their average-sized counterpart (hazard ratio 0.47; 95% confidence interval 0.29-0.75, P = .002). At the end of follow-up, 14/23 (60.9%) of cases versus 35/46 of controls (76.1%) had received a liver transplantation. Conclusion: Small adults with a bodyweight below 60 kg are disadvantaged on the waitlist for a size-matched whole liver graft.

Full‐left‐full‐right split liver transplantation for adult recipients: a systematic review and meta‐analysis

“…Although the survival benefit of FSLT needs to be carefully balanced against the associated risks, survival after FSLT may not be inferior to other accepted graft‐to‐recipient matches. FSLT may in particular benefit small adult recipients, who are reported to be disadvantaged on the waitlist with longer waiting times, resulting in progression of liver disease, increased waitlist morality, and drop‐out [ 6 , 7 , 34 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. At the same time, patient physiology and anatomy need to support the additional risks of complications and the technical complexity of split liver transplantation.…”

“…Since one liver graft can be shared between two adult recipients, FSLT may increase the number of available grafts and reduce waitlist time and mortality [ 3 , 4 , 5 ]. This technique may especially favor smaller adolescent and adult patients, who are disadvantaged on the waiting list to receive a timely size‐matched graft [ 6 , 7 ].…”

Addressing sex-based disparities in liver transplantation

“…Furthermore, Nephew et al [32] found recipient body surface area mediated the higher rate of organ decline seen in women positioned at the top of the waitlist. Another small study grouping liver transplantation recipients by weight (above or below 60 kg) demonstrated that graft survival after liver transplantation was similar in both groups despite the use of less stringent size-matching criteria [33]. Relaxed parameters for size mismatch and the increased risks of accepting larger livers have not been well characterized, presenting an avenue for further investigation.…”

Split liver transplantation for two adult recipients: A collective review of Korean experience

“…Since one liver graft can be shared between two adult recipients, SLT2A increases the number of available grafts and reduces the waitlist time and mortality [3][4][5]. This technique might especially favor smaller adolescents and adult patients who are disadvantaged on the waiting list to receive a timely size-matched graft [6][7][8]. The world-first case of SLT2A was reported in 1989 [1].…”