Date: Tuesday, May 5, 2015
Session Time: 2:15pm-3:45pm
Presentation Time: 3:15pm-3:27pm
Location: Room 115-AB
Living donor liver transplantation (LDLT) has been expanded worldwide and the outcome of even adult-to-adult LDLT using left lobe reported to be equivalent to that of whole liver cadaveric liver transplantation. In spite of these positive results, allograft dysfunction due to small-for-size syndrome (SFSS) remains one of the main determinants of the recipient prognosis, and donor and graft selection in LDLT remain to be critically important.
We retrospectively investigated the LDLT cases to identify the risk factors for graft loss associated with SFSS, and appropriate graft selection method for each recipient.
Patients and methods
Consecutive 138 adult recipients who underwent LDLT between 1999 and 2014 in our hospital were enrolled in this study. Preoperative and intraoperative variables as well as postoperative highest serum bilirubin level within 4 weeks (HBIL) after LDLT were compared.
Preoperative variables including MELD score, GW/SLV, and donor age, which were significantly associated with SFSS related graft failure, were evaluated using multivariate logistic regression analysis.
Among 138 adult LDLT recipients, 11 recipients lost grafts 2.12±1.23 months after surgery due to the allograft dysfunction or complications associated with SFSS. Univariate analyses determined risk factor for graft loss as MELD score (P<0.001), graft weight standard liver volume ratio (GW/SLV) (P=0.002), operative duration (P=0.006), and HBIL (P<0.001). Multivariate logistic regression analysis revealed that MELD score and GW/SLV were identified as the independent risk factors for SFSS related graft failure (P<0.001, 0.013, respectively). Combination of these two variables demonstrated excellent determinant of SFSS related graft failure with AUC =0.960 in ROC curve. Minimal requirement of graft volume could be determined by MELD score using the equation; SLV x(SQRT((MELD-20.83)^2/72.56-2.79)x0.0113)+0.4603) (MELD>35), SLV x(-SQRT(-(MELD-20.83)^2/72.56+2.79)x0.0113)+0.4603) (MELD <35), where SLV is standard liver volume (ml), SQRT is square root, and MELD is MELD score.
Patient with high MELD score requires larger graft. Graft and donor selection in LDLT should be determined according to preoperative MELD score in order to prevent postoperative SFSS related graft failure.
To cite this abstract in AMA style:Marubashi S, Tomokuni A, Tomimaru Y, Asaoka T, Wada H, Eguchi H, Umeshita K, Doki Y, Mori M, Nagano H. Impact of Preoperative MELD Score On Small for Size Syndrome in Living Donor Liver Transplantation [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/impact-of-preoperative-meld-score-on-small-for-size-syndrome-in-living-donor-liver-transplantation/. Accessed February 23, 2019.
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