Minimum Graft Size Avoiding Small-for-Size Associated Early Graft Failure in Living Donor Liver Transplantation.

S. Marubashi,¹ H. Nagano,³ H. Eguchi,² H. Wada,² K. Umeshita,² Y. Doki,² M. Mori,² N. Sato,¹ T. Kimura,¹ A. Kenjyo,¹ M. Gotoh.¹

¹Regenerative Surgery, Fukushima Medical University, Fukushima, Japan
²Surgery, Osaka University Graduate School of Medicine, Suita, Japan.

Meeting: 2016 American Transplant Congress

Abstract number: A199

Keywords: Graft failure, Living-related liver donors, Outcome

Session Information

Session Name: Poster Session A: Living Donor Liver Transplantation

Session Type: Poster Session

Date: Saturday, June 11, 2016

Session Time: 5:30pm-7:30pm

Presentation Time: 5:30pm-7:30pm

Location: Halls C&D

Small-for-size syndrome (SFSS) is a serious complication in living donor liver transplantation (LDLT). The aim of this study was to investigate the risk factors for graft failure, which associated with SFSS.

Patients and methods: 138 consecutive recipients of adult-to-adult LDLT between 1999 and Oct 2014 in our hospital were included in this study. We investigated the factors associated with small-for-size associated early graft loss (SAGL) using univariate/multivariate logistic regression analyses. Furthermore, a novel prediction model for SAGL was created using pre-operatively assessable risk factors.

Results: Twelve of the transplant recipients (8.8%) had SAGL. In multivariate logistic regression analyses using pre-operatively assessed variables, the pre-operative MELD score (P<0.001) and actual graft weight/recipient standard liver volume (SLV) ratio (P=0.008) were independent predictors of SAGL. The recommended graft volume by pre-operative CT volumetry was calculated as SLV x (1.616 x MELD+0.344)/100/0.85 (ml) [MELD ≥ 18.2], or SLV x 0.35 (ml) [MELD < 18.2]. The minimal graft volume was also calculated as SLV x (1.616 x MELD-14.139) /100/0.85 (ml) [MELD ≥ 27.2], or SLV x 0.35 (ml) [MELD < 27.2].

2D map with MELD and the graft volume/SLV ratio is shown in Figure. Zone A (with low risk of SAGL) is defined the area over “Recommended graft volume” by pre-operative CT volumetry. Zone B (with acceptable risk of SAGL); the area over “Minimal graft volume.” Zone C (with high risk of SAGL); the area below “Minimal graft volume.” Once you calculate the preoperative MELD score, the risk of SAGL is well determined by the graft volume/SLV ratio. For example, if MELD score is 30, the graft volume/SLV ratio should be over 57.4% for Zone A.

Conclusion:The required allograft volume in LDLT can be determined by the pre-operative MELD score of the recipient. Patients with higher MELD scores require larger grafts or even deceased donor whole liver transplant to avoid SAGL.

CITATION INFORMATION: Marubashi S, Nagano H, Eguchi H, Wada H, Umeshita K, Doki Y, Mori M, Sato N, Kimura T, Kenjyo A, Gotoh M. Minimum Graft Size Avoiding Small-for-Size Associated Early Graft Failure in Living Donor Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).

To cite this abstract in AMA style:

Marubashi S, Nagano H, Eguchi H, Wada H, Umeshita K, Doki Y, Mori M, Sato N, Kimura T, Kenjyo A, Gotoh M. Minimum Graft Size Avoiding Small-for-Size Associated Early Graft Failure in Living Donor Liver Transplantation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/minimum-graft-size-avoiding-small-for-size-associated-early-graft-failure-in-living-donor-liver-transplantation/. Accessed May 21, 2025.

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