Impact of Graft Size Mismatching on Graft Prognosis in Liver Transplantation From Living Donors1,2

Kiuchi, Tetsuya; Kasahara, Mureo; Uryuhara, Kenji; Inomata, Yukihiro; Üemoto, Shinji; Asonuma, Katsuhiro; Egawa, Hiroto; Fujita, Shiro; Hayashi, Michihiro; Tanaka, Kōichi

doi:10.1097/00007890-199901270-00024

Cited by 897 publications

(792 citation statements)

References 26 publications

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“…Graft mass is a critical variable affecting outcomes and a limitation in the extension of SLT between two adults. Adequate graft mass has been extensively explored in living donor liver transplantation with minimal graft thresholds advocated (48)(49)(50)(51)(52); however, these data are not directly applicable to SLT as parenchyma quality, and immediate function of living donor grafts exceeds that of cadavers (27,53,54). Our preference is a graft mass of at least 1% recipient body weight; however, grafts less than 0.8% recipient body weight have been utilized with success (30,55,56).…”

Section: Technical Considerationsmentioning

confidence: 99%

Split-Liver Transplantation: A Review

Renz

Yersiz

Reichert

et al. 2003

American Journal of Transplantation

104

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Split-liver transplantation (SLT), a procedure where one cadaver liver is divided to provide for two recipients, offers immediate expansion of the existing cadaver donor pool. To date, the principal beneficiaries of SLT have been adult/pediatric recipient pairs with excellent outcomes reported; however, the current scarcity of cadaver organs has renewed interest in expanding these techniques to include two adult recipients from one adult cadaver donor. Significant obstacles to the widespread application of SLT exist and must be resolved by the transplant community before greater utilization can be realized. This manuscript reviews the historic background, surgical techniques, current results, and obstacles impeding further application of SLT.

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Section: Technical Considerationsmentioning

confidence: 99%

Split-Liver Transplantation: A Review

Renz

Yersiz

Reichert

et al. 2003

American Journal of Transplantation

104

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“…However, with reduction of graft size, chances of primary graft nonfunction and complications also increase (1,2). Our previous study revealed that complications might be related to microcirculatory injuries that arose from transient portal hypertension (3).…”

Section: Introductionmentioning

confidence: 99%

Linking Inflammation to Acute Rejection in Small-For-Size Liver Allografts: The Potential Role of Early Macrophage Activation

Yang

Chu

et al. 2004

American Journal of Transplantation

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This study aims to investigate the immunological status of small-for-size liver allografts and possible mechanism that contributes to the accelerated immune response in these allografts. Eight experimental groups were: whole isografts; 40% isografts; whole allografts, no treatment; 40% allografts, no treatment; whole allografts with sodium salicylate intraperitoneal injection, D0-3; 40% allografts with sodium salicylate, D0-3; whole allografts with FK506 intramuscular injection D0-3, and 40% allografts with FK506, D0-3. The 40% allografts survived significantly shorter than whole allografts (p = = 0.02). At 72 h after reperfusion, a higher number of macrophages infiltrated into the periportal area of small-for-size allografts than whole allografts. Remarkable up-regulation of interleukin-1b (IL-1b ), interleukin-2 (IL-2), interleukin-10 (IL-10) and interferon-c (IFN-c ) messenger RNA (mRNA) levels were detected in small-for-size allografts within 24 h after reperfusion. Sodium salicylate administration reduced IL-1b and IFN-c mRNA in both small-for-size and whole allografts, but it could decrease IL-2 and IL-10 mRNA levels only in small-for-size allografts. In vitro study revealed that CD80, CD86 and CD11b expression on macrophages was augmented after IL-1b stimulation, whereas the up-regulation could be blocked by sodium salicylate. In conclusion, early activation of macrophages as a result of graft injury might play an important role in the accelerated acute rejection process in small-for-size allografts.

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“…The graft size is one of the most important factors for recipient survival. Kiuchi et al 5 reported that a GRWR < 0.8% may lead to poor graft survival. Seven of the 13 recipients in this study received an RPS graft with a low weight (GRWR < 0.8%); however, none of the recipients had small-for-size graft dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…It is well known that adequate donor liver volumetry is one of the key factors for both the safety of living donors and the survival of recipients of adult-to-adult LDLT. 4,5 In addition to an adequate liver volume, the selection of the appropriate liver graft from the donor might be critical for successful adult-to-adult LDLT.In adult-to-adult LDLT, the size of the left lobe (LL) graft is frequently insufficient to meet the metabolic demands of the recipient, whereas the size of the right lobe (RL) graft usually satisfies the liver volume requirements of the recipient. However, RL donation carries a higher risk to the donor than LL donation.…”

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confidence: 99%

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Volumetry-based selection of right posterior sector grafts for adult living donor liver transplantation

Kim

Wang

et al. 2011

Liver Transpl

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To determine the feasibility of volumetric criteria without anatomic exclusion for the selection of right posterior sector (RPS) grafts for adult-to-adult living donor liver transplantation (LDLT), we reviewed and compared our transplant data for RPS grafts and right lobe (RL) grafts. Between January 2008 and September 2010, adult-to-adult LDLT was performed 65 times at our institute; 13 of the procedures (20%) were performed with RPS grafts [the posterior sector (PS) group], and 39 (60%) were performed with RL grafts (the RL group). The volumetry of the 13 RPS donor livers showed that the RPS volume was 39.8% 6 7.6% of the total liver volume. Ten of the 13 donors had to donate RPS grafts because the left liver volume was inadequate. All donor procedures were performed successfully, and all donors recovered from hepatectomy. However, longer operative times were required for the procurement of RPS grafts versus RL grafts (418 6 40 versus 345 6 48 minutes, P < 0.001). The postoperative recovery of liver function was smoother for the donors of the PS group versus the donors of the RL group. The RPS grafts had significantly smaller hepatic artery and bile duct openings than the RL grafts. All recipients with RPS grafts survived LDLT. No recipients experienced vascular graft complications or small-for-size graft dysfunction. There were no significant differences in the incidence of posttransplant complications between the donors and recipients of the PS and RL groups. The 3-year graft survival rates were favorable in both groups (100% in the PS group versus 91% in the RL group). In conclusion, the selection of RPS grafts by volume criteria is a feasible strategy for an adult-to-adult LDLT program. Liver Transpl 17:1046-1058, 2011. V C 2011 AASLD.Received January 26, 2011; accepted May 7, 2011.Living donor liver transplantation (LDLT) is widely performed for end-stage liver disease, especially in countries in which deceased donors are scarce. [1][2][3] However, an LDLT program is more complicated than a deceased donor liver transplantation program because of the living sources of the grafts. Adult-toadult LDLT can be performed successfully when appropriate preoperative evaluations, surgical procedures, and postoperative management techniques are used for the donor and the recipient. It is well known that adequate donor liver volumetry is one of the key factors for both the safety of living donors and the survival of recipients of adult-to-adult LDLT. 4,5 In addition to an adequate liver volume, the selection of the appropriate liver graft from the donor might be critical for successful adult-to-adult LDLT.In adult-to-adult LDLT, the size of the left lobe (LL) graft is frequently insufficient to meet the metabolic demands of the recipient, whereas the size of the right lobe (RL) graft usually satisfies the liver volume requirements of the recipient. However, RL donation carries a higher risk to the donor than LL donation.Abbreviations: ALT, alanine aminotransferase; CHD, common hepatic duct; CT, computed tomography; DD...

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Impact of Graft Size Mismatching on Graft Prognosis in Liver Transplantation From Living Donors1,2

Cited by 897 publications

References 26 publications

Split-Liver Transplantation: A Review

Split-Liver Transplantation: A Review

Linking Inflammation to Acute Rejection in Small-For-Size Liver Allografts: The Potential Role of Early Macrophage Activation

Volumetry-based selection of right posterior sector grafts for adult living donor liver transplantation

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