Using low graft/recipient’s body weight ratio graft with portal flow modulation an effective way to prevent small-for-size syndrome in living-donor liver transplant: A retrospective analysis

Objectives: Small-sized grafts are associated with high rates of graft failure and small-for-size syndrome. Portal flow is a causative factor for smallfor- size syndrome. We sought to evaluate early graft dysfunction in smaller-sized grafts and the study factors responsible for it. Materials and Methods: A total of 450 patients underwent a living-donor liver transplant from January 2010 to June 2013. Fifty-four grafts with graft/recipient’s body weight ratio less than 0.8 were included in the study. We used a splenic artery ligation or splenectomy for portal flow modulation if the portal flow after reperfusion was greater than 250 mL/min/100 g. Small-for-size syndrome was defined according to Clavien and Kyushu university definitions. Portal flow was measured with Doppler ultrasound flowmetry. Factors responsible for early graft dysfunction also were analyzed. Results: Six patients out of 54 developed small-forsize syndrome in smaller size group (graft/recipient’s body weight ratio < 0.8). There were 28 left lobe grafts and 26 right lobe grafts. Sixteen out of 132 patients from the control group fulfilled the definitions of small-for-size syndrome. There was no statistical significant difference in graft dysfunction between low graft/recipient’s body weight ratio group and high graft/recipient’s body weight ratio group. On univariate analysis Hepatitis C, Hepatitis B and HCC as etiologies, Model for End-stage Liver diease score, and portal flow achieved statistical significane as factors associated with graft dysfunction (P <.05). On multivariate analysis, only portal flow achieved statistical significance. Conclusions: Lower graft/recipient’s body weight ratio graft with portal flow modulation in case of high portal flow is an effective way to increase donor pool and donor safety with low risk of smallfor- size syndrome. Portal flow is mainly responsible for small-for-size syndrome or early graft dysfunction.