Small for size syndrome difficult dilemma: lessons from 10 years single centre experience in living donor liver transplantation

Shoreem, H.; Gad, Emad Hamdy; Saliman, H.; Hegazy, Osama; Saleh, Sherif; Zakaria, Hazem; El-Ella, K. Abou; Ibrahim, T.

doi:10.1016/j.hpb.2016.01.426

Cited by 3 publications

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“…Small graft size leading to small for size syndrome can result in poor bile production, delayed synthetic function, prolonged cholestasis, and intractable ascites with subsequent septic complications and higher mortality, 18‐21 as seen in our study. Therefore strategies focusing on the prevention and early treatment of SSI and suitable graft size may have a suitable benefit of prevention or reducing the risk of IH formation following abdominal organ transplantation.…”

Section: Discussionsupporting

confidence: 62%

Risk factors and management of incisional hernia in the recipients of living donor liver transplant: A single institutional experience

et al. 2020

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Aim Incisional hernia (IH) has a wide range of incidence after liver transplant (LT), with reported different risk factors. The aim of the study was to shed more light on the incidence, risk factors, and management of IH after living donor liver transplantation (LDLT). Methods Adult recipients who underwent LDLT between April 2004 and December 2017 were retrospectively studied. The patients were divided into a group of post‐LDLT IH and another group without IH. Results A total of 239 recipients who underwent LDLT, 35 patients (14.6%) had post LT IH. The independent risk factors for post‐LDLT IH were, presence of hepatocellular carcinoma (HCC) pre‐transplant, small graft weight, prolonged warm ischaemia time (WIT), postoperative bile leak, postoperative surgical site infection (SSI), (all P values <.05). The commonest site for hernia was the midline skin incision (65.7%). Eighteen recipients (51.4%) with IH underwent repair by mesh hernioplasty with no recurrence. Conclusions The following variables have been shown to be significant risk factors for the development of post‐LDLT IH: HCC indication for LDLT; small graft weight; prolonged WIT; and postoperative complications like bile leak and SSI. Mesh hernioplasty is the treatment of choice for this complication.

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Section: Discussionsupporting

confidence: 62%

Risk factors and management of incisional hernia in the recipients of living donor liver transplant: A single institutional experience

et al. 2020

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“…However, they observed an earlier decline in bilirubin and international normalized ratio levels by POD 7 in the younger donor group. (26) Using SFSGs solely was previously reported to be associated with poorer outcomes, (5,27,28) but the research has since changed to conclude that graft size is not the only factor contributing to the outcomes of SFSGs. Moon et al reported that ALDLT using a right lobe with GRWR <0.8% can be performed safely when grafts from young donors (<44 years old) are used and attention is paid to MHV tributary drainage.…”

Section: Discussionmentioning

confidence: 99%

Older Donor Age Is a Risk Factor for Negative Outcomes After Adult Living Donor Liver Transplantation Using Small‐for‐Size Grafts

et al. 2019

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Adult‐to‐adult living donor liver transplantation (ALDLT) using small‐for‐size grafts (SFSGs), ie, a graft with a graft‐to‐recipient weight ratio (GRWR) <0.8%, has been a challenge that should be carefully dealt with, and risk factors in this category are unclear. Therefore, we aimed to examine the risk factors and outcomes of ALDLT using SFSGs over a 13‐year period in 121 patients who had undergone their first ALDLT using SFSGs. Small‐for‐size syndrome (SFSS), early graft loss, and 1‐year mortality were encountered in 21.6%, 14.9%, and 18.4% of patients, respectively. By multivariate analysis, older donor age (≥45 years) was an independent risk factor for SFSS (odds ratio [OR], 4.46; P = 0.004), early graft loss (OR, 4.11; P = 0.02), and 1‐year mortality (OR, 3.76; P = 0.02). Child‐Pugh C class recipients were associated with a higher risk of SFSS development (P = 0.013; OR, 7.44). Despite no significant difference between GRWR categories in the multivariate outcome analysis of the whole population, in the survival analysis of the 2 donor age groups, GRWR <0.6% was associated with significantly lower 1‐year survival than the other GRWR categories in the younger donor group. Moreover, in the high final portal venous pressure (PVP) group (>15 mm Hg), younger ABO‐compatible donors showed 100% 1‐year survival with a significant difference from the group of other donors. Older donor age was an independent risk factor for SFSS, early graft loss, and 1‐year mortality after ALDLT using SFSGs. GRWR should not be <0.6%, and PVP modulation is indicated when grafts from older or ABO‐incompatible donors are used.

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“…Small‐for‐size syndrome (SFSS) in LDLT, a multifactorial disease caused by both donor and recipient factors, has a poor postoperative prognosis mainly due to sinusoidal microcirculatory disturbances after portal reflow 5 . Prophylactic measures against SFSS are represented by portosystemic shunts, splenectomy to modulate portal pressure, splenic arterial ligation/embolization, somatostatin and its analogs, and larger graft selection based on the graft‐to‐recipient weight ratio (GRWR), but no effective treatments have been established 6‐11 . In rats with SFSS, treatment with stem cells such as mesenchymal stem cells (MSCs) and adipose‐derived stem cells is reported to be effective 12‐14 …”

Section: Introductionmentioning

confidence: 99%

Protection of liver sinusoids by intravenous administration of human Muse cells in a rat extra-small partial liver transplantation model

Shono

Kushida

Wakao

et al. 2021

American Journal of Transplantation

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Small‐for‐size syndrome (SFSS) has a poor prognosis due to excessive shear stress and sinusoidal microcirculatory disturbances in the acute phase after living‐donor liver transplantation (LDLT). Multilineage‐differentiating stress enduring (Muse) cells are reparative stem cells found in various tissues and currently under clinical trials. These cells selectively home to damaged sites via the sphingosine‐1‐phosphate (S1P)–S1P receptor 2 system and repair damaged tissue by pleiotropic effects, including tissue protection and damaged/apoptotic cell replacement by differentiating into tissue‐constituent cells. The effects of intravenously administered human bone marrow‐Muse cells and ‐mesenchymal stem cells (MSCs) (4 × 105) on liver sinusoidal endothelial cells (LSECs) were examined in a rat SFSS model without immunosuppression. Compared with MSCs, Muse cells intensively homed to the grafted liver, distributed to the sinusoids and vessels, and delivered improved blood chemistry and Ki‐67(+) proliferative hepatocytes and ‐LSECs within 3 days. Tissue clearing and three‐dimensional imaging by multiphoton laser confocal microscopy revealed maintenance of the sinusoid continuity, organization, and surface area, as well as decreased sinusoid interruption in the Muse group. Small‐interfering RNA‐induced knockdown of hepatocyte growth factor and vascular endothelial growth factor‐A impaired the protective effect of Muse cells on LSECs. Intravenous injection of Muse cells might be a feasible approach for LDLT with less recipient burden.

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Small for size syndrome difficult dilemma: lessons from 10 years single centre experience in living donor liver transplantation

Cited by 3 publications

References 0 publications

Risk factors and management of incisional hernia in the recipients of living donor liver transplant: A single institutional experience

Risk factors and management of incisional hernia in the recipients of living donor liver transplant: A single institutional experience

Older Donor Age Is a Risk Factor for Negative Outcomes After Adult Living Donor Liver Transplantation Using Small‐for‐Size Grafts

Protection of liver sinusoids by intravenous administration of human Muse cells in a rat extra-small partial liver transplantation model

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