Lower limit of graft size in adult Living donor liver transplantation (LDLT) is not well established. This study examines the outcomes with use of small-for-size grafts (SFSGs) in LDLT in a single center. Graft-to-recipient weight ratio (GRWR) of less than 0.8 was designated as SFSG. From 2002-15, 41 cases of adult-to-adult LDLT with a GRWR of <0.8 were performed at the center. These constituted 24 left lobes. These were compared to all adult LDLTs with GRWR >/=0.8 (n=95) carried out in the same time period. Median follow-up duration was 3.1 years. Mean GRWR of SFSGs was 0.66 versus 1.06 (p<0.0001) in the larger graft group. SFSGs consisted of significantly more left lobes (58.5% versus 21%, p<0.0001) as compared to the larger group. HCV and HCC constituted a significantly higher proportion of cases in the smaller group (60.9% versus 42.1%, p=0.043, 34% versus 16.8%, p=0.026). Preoperative MELD scores were not different between the groups

. Rate of biliary strictures was not different between the groups (39% versus 31.6%, p=0.4). Liver synthetic function and kidney function at 1 and 3-years post transplant were comparable between the groups. The 1 and 3-year graft survival for GRWR<0.8 group were 87% and 80% compared to 90% and 86% for the larger group (p=0.55) . The 1 and 3-year patient survival for GRWR<0.8 group were 89% and 82% compared to 92% and 88% for the larger group (p=0.55) . Use of smaller grafts composed predominantly of left lobes had comparable outcomes with larger grafts and potentially expands applicability of LDLT.

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CITATION INFORMATION: Klair T, Przybyszewski E, Samstein B. Outcomes of Small-for-Size Grafts in Adult Living Donor Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).

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