Purpose: Graft size is a critical issue in living donor liver transplantation (LDLT). We hypothesized that too much portal flow could possibly be diverted into pre-existing collateral veins, alleviating small-for-size syndrome (SFSS) in LDLT. This study evaluated the impact of the preserved collateral veins in the outcomes of LDLT using a small-for-size graft (SFSG).

Methods: For patient safety, a graft-to-recipient weight ratio (GRWR) < 0.8% was strictly confined to patients with collateral veins (group A), and the patient group was compared in a 1:3 ratio to a matched group of patients with GRWR ≥ 0.8% (group B) using propensity score analysis.

Results: Forty and 120 patients were included in group A and B, respectively. No significant differences in baseline patient characteristics were observed between the 2 groups except for graft weight and GRWR. The lowest GRWR was 0.4%. The graft portal inflow showed no significant differences for 7 days after graft implantation, ranging from 1,668 to 5,100 mL/min. SFSS occurred in no patients (0.0%) in group A and in 10 (8.3%) in group B (p =0.067). Overall survival rates at 1, 3, and 5 years were not different between the two groups (85.0%, 82.5%, and 82.5% versus 92.5%, 86.7%, and 85.0%, p = 0.670).

Conclusion: Pre-existing collateral veins saved during surgery may have a reserve buffer for excessive portal flow to obviate SFSS in LDLT.

CITATION INFORMATION: Na B-.G., Lee E., Kim S., Park S. Impact of Preserved Collateral Veins on Small-for-Size Grafts in Living Donor Liver Transplantation Am J Transplant. 2017;17 (suppl 3).

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