The Risk of Going Small

Wong, Tiffany Cho‐Lam; Fung, James; Cui, Tracy Y S; Sin, Sui‐Ling; W, K; She, Brian W H; Chan, Albert; Chok, Kenneth S. H.; Dai, Jeff; Cheung, Tan To; Lo, Chung‐Mau

doi:10.1097/sla.0000000000003824

Cited by 45 publications

(4 citation statements)

References 47 publications

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“…Good venous outflow is as important as vascular inflow and graft size and contributed to the success of LDLT. (20) In conclusion, for patients with MELD > 25 and HRS, the ITT-LDLT approach reduced waitlist mortality by providing earlier access to transplant, particularly within the first month after listing when the mortality risk without transplant was the highest. A consistent survival benefit was observed across all MELD strata.…”

Section: Discussionmentioning

confidence: 90%

“…Although the success of LDLT is multifactorial, the application of LDLT should not be limited by a certain MELD cutoff. (20) With the advancement of surgical, anesthetic, and perioperative care, many centers that predominately perform DDLT also reported excellent outcomes after LDLT. (5,10,27) Lastly, it is worth noting that right-lobe grafts with inclusion of MHV were the predominant graft type in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Although a predicted GRWR > 0.8% is preferable, GRWR ≥ 0.6%-0.8% can be allowed in the following situations: (1) absence of alternative living donor; (2) primary transplant; (3) recipient has no >2 organ failures; and (4) both donors and recipients accept a higher perioperative morbidity and mortality rate. (20) Approval must be obtained from an independent statutory human organ transplant board for LDLT between persons who were not genetically related or a couple whose marriage has subsisted for <3 years. (21) tRaNSplaNt opeRatIoN Operation was standardized as described (22) (Supporting Information).…”

Section: Donor Evaluationmentioning

confidence: 99%

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Analysis of Survival Benefits of Living Versus Deceased Donor Liver Transplant in High Model for End‐Stage Liver Disease and Hepatorenal Syndrome

et al. 2021

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BaCKgRoUND aND aIMS: Previous recommendations suggested living donor liver transplantation (LDLT) should not be considered for patients with Model for End-Stage Liver Disease (MELD) > 25 and hepatorenal syndrome (HRS). appRoaCH aND ReSUltS: Patients who were listed with MELD > 25 from 2008 to 2017 were analyzed with intention-to-treat (ITT) basis retrospectively. Patients who had a potential live donor were analyzed as ITT-LDLT, whereas those who had none belonged to ITT-deceased donor liver transplantation (DDLT) group. ITT-overall survival (OS) was analyzed from the time of listing. Three hundred twentyfive patients were listed (ITT-LDLT n = 212, ITT-DDLT n = 113). The risk of delist/death was lower in the ITT-LDLT group (43.4% vs. 19.8%, P < 0.001), whereas the transplant rate was higher in the ITT-LDLT group (78.3% vs. 52.2%, P < 0.001). The 5-year ITT-OS was superior in the ITT-LDLT group (72.6% vs. 49.5%, P < 0.001) for patients with MELD > 25 and patients with both MELD > 25 and HRS (56% vs. 33.8%, P < 0.001). Waitlist mortality was the highest early after listing, and the distinct alteration of slope at survival curve showed that the benefits of ITT-LDLT occurred within the first month after listing.Perioperative outcomes and 5-year patient survival were comparable for patients with MELD > 25 (88% vs. 85.4%, P = 0.279) and patients with both MELD > 25 and HRS (77% vs. 76.4%, P = 0.701) after LDLT and DDLT, respectively. The LDLT group has a higher rate of renal recovery by 1 month (77.4% vs. 59.1%, P = 0.003) and 3 months (86.1% vs, 74.5%, P = 0.029), whereas the long-term estimated glomerular filtration rate (eGFR) was similar between the 2 groups. ITT-LDLT reduced the hazard of mortality (hazard ratio = 0.387-0.552) across all MELD strata. CoNClUSIoNS:The ITT-LDLT reduced waitlist mortality and allowed an earlier access to transplant. LDLT in patients with high MELD/HRS was feasible, and they had similar perioperative outcomes and better renal recovery, whereas the long-term survival and eGFR were comparable with DDLT. LDLT should be considered for patients with high MELD/ HRS, and the application of LDLT should not be restricted with a MELD cutoff. (Hepatology 2021;0:1-14).T he utilization of living donor liver transplantation (LDLT) for patients with high Model for End-Stage Liver Disease (MELD) scores is

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Donor Evaluationmentioning

confidence: 99%

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Analysis of Survival Benefits of Living Versus Deceased Donor Liver Transplant in High Model for End‐Stage Liver Disease and Hepatorenal Syndrome

et al. 2021

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“…Recently, Hong Kong group 28 reported that GRWR in LDLT could be lowered to 0.6%, even as low as 0.46%, with satisfactory outcomes. However, it needs to be recognized that they used a dividing a factor of 1.19 for converting the value of calculated graft volume (GV) to the expected one.…”

Section: Small -For-size Graftmentioning

confidence: 99%

Small‐for‐size graft, small‐for‐size syndrome and inflow modulation in living donor liver transplantation

Ikegami

Onda

Furukawa

et al. 2020

J Hepato Biliary Pancreat

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The extended application of living donor liver transplantation (LDLT) has revealed the problem of graft size mismatching called "small-for-size syndrome (SFSS)." The initial trials to resolve this problem involved increasing the procured graft size, from left to right, and even extending to include a right lobe graft. Clinical cases of living right lobe donations have been reported since then, drawing attention to the risks of increasing the liver volume procured from a living donor. However, not only other modes of increasing graft volume (GV) such as auxiliary or dual liver transplantation, but also control of the increased portal pressure caused by a small-for-size graft (SFSG), such as a porto-systemic shunt or splenectomy and optimal outflow reconstruction, have been trialed with some positive results. To establish an effective strategy for transplanting SFSG and preventing SFSS, it is essential to have precise knowledge and tactics to evaluate graft quality and GV, when performing these LDLTs with portal pressure control and good venous outflow. Thus, we reviewed the updated literature on the pathogenesis of and strategies for using SFSG.

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Liver Transplantation in the Middle East

Yılmaz

2021

Liver Cancer in the Middle East

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The Risk of Going Small

Abstract: Supplemental Digital Content is available in the text

Cited by 45 publications

References 47 publications

Analysis of Survival Benefits of Living Versus Deceased Donor Liver Transplant in High Model for End‐Stage Liver Disease and Hepatorenal Syndrome

Analysis of Survival Benefits of Living Versus Deceased Donor Liver Transplant in High Model for End‐Stage Liver Disease and Hepatorenal Syndrome

Small‐for‐size graft, small‐for‐size syndrome and inflow modulation in living donor liver transplantation

Liver Transplantation in the Middle East

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