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The outcomes of pediatric living donor liver transplantation using small-for-size grafts: experience of a single institute

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Abstract

Purpose

We aimed to evaluate patients who had undergone pediatric LDLT with small-for-size graft (SFSG) and identify risk factors of graft failure to establish a preoperative graft selection strategy.

Methods

The data was collected retrospectively. SFSG was used in 14LDLTs (5.7 %) of 245 LDLTs performed between May 2001 and March 2014. The mean patient age and body weight at LDLT were 12.6 ± 2.0 years and 40.5 ± 9.9 kg, respectively. The graft type was left lobe in six patients, left + caudate lobe in seven patients, and posterior segment in one patient.

Results

The graft survival rates in SFSG and non-SFSG groups were 78.9 and 93.1 %, respectively (p = 0.045). In the univariate analysis, bleeding volume during LDLT were an independent risk factors for graft failure (p = 0.011). Graft failure was caused by sepsis in all three patients and occurred at a median of 70 postoperative days 70 (range 14–88 days). Among them, two cases showed high preoperative PELD/MELD score (PELD; 19.4 and MELD; 22, respectively).

Conclusions

Pediatric LDLT using SFSG had poor outcome and prognosis, especially when it accompanies the surgical infectious complications with preoperative high PELD/MELD scores.

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Abbreviations

LDLT:

Living-donor liver transplantation

SFSS:

Small-for-size syndrome

SFSG:

Small-for-size graft

GV:

Graft volume

SLV:

Standard liver volume

MELD:

Model for end-stage liver disease

PELD:

Pediatric end-stage liver disease

PV:

Portal vein

References

  1. Kiuchi T, Kasahara M, Uryuhara K, Inomata Y, Uemoto S, Asonuma K et al (1999) Impact of graft size mismatching on graft prognosis in liver transplantation from living donors. Transplantation 67:321–327

    Article  CAS  PubMed  Google Scholar 

  2. Ikegami T, Shimada M, Imura S, Arakawa Y, Nii A, Morine Y et al (2008) Current concept of small-for-size grafts in living donor liver transplantation. Surg Today 38:971–982

    Article  PubMed  Google Scholar 

  3. Dahm F, Georgiev P, Clavien PA (2005) Small-for-size syndrome after partial liver transplantation: definition, mechanisms of disease and clinical implications. Am J Transplant 5:2605–2610

    Article  PubMed  Google Scholar 

  4. Sugawara Y, Makuuchi M, Takayama T, Imamura H, Dowaki S, Mizuta K et al (2001) Small-for-size grafts in living-related liver transplantation. J Am Coll Surg 192:510–513

    Article  CAS  PubMed  Google Scholar 

  5. Fan ST, Lo CM, Liu CL, Yong BH, Wong J (2003) Determinants of hospital mortality of adult recipients of right lobe live donor liver transplantation. Ann Surg 238:864–869 (discussion 869–870)

    Article  PubMed  PubMed Central  Google Scholar 

  6. Shimada M, Ijichi H, Yonemura Y, Harada N, Shiotani S, Ninomiya M et al (2004) Is graft size a major risk factor in living-donor adult liver transplantation? Transpl Int 17:310–316

    Article  CAS  PubMed  Google Scholar 

  7. Tsunematsu I, Ogura Y, Inoue K, Koizumi A, Tanigawa N, Tanaka K (2006) Quantitative survival model for short-term survival after adult-to-adult living donor liver transplantation. Liver Transpl 12:904–911

    Article  PubMed  Google Scholar 

  8. Nishizaki T, Ikegami T, Hiroshige S, Hashimoto K, Uchiyama H, Yoshizumi T et al (2001) Small graft for living donor liver transplantation. Ann Surg 233:575–580

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Kasahara M, Umeshita K, Inomata Y, Uemoto S (2013) Japanese Liver Transplantation Society Long-term outcomes of pediatric living donor liver transplantation in Japan: an analysis of more than 2200 cases listed in the registry of the Japanese Liver Transplantation Society. Am J Transplant 13(7):1830–1839

    Article  CAS  PubMed  Google Scholar 

  10. Urata K, Kawasaki S, Matsunami H, Hashikura Y, Ikegami T, Ishizone S et al (1995) Calculation of child and adult standard liver volume for liver transplantation. Hepatology 21:1317–1321

    Article  CAS  PubMed  Google Scholar 

  11. Lei JY, Wang WT, Yan LN (2012) Risk factors of SFSS in adult-to-adult living donor liver transplantation using the right liver: a single-center analysis of 217 cases. Hepatogastroenterology 59:1491–1497

    PubMed  Google Scholar 

  12. Chan SC, Fan ST, Chok KS, Sharr WW, Dai WC, Fung JY et al (2012) Increasing the recipient benefit/donor risk ratio by lowering the graft size requirement for living donor liver transplantation. Liver Transpl 18:1078–1082

    Article  PubMed  Google Scholar 

  13. Roll GR, Parekh JR, Parker WF, Siegler M, Pomfret EA, Ascher NL et al (2013) Left hepatectomy versus right hepatectomy for living donor liver transplantation: shifting the risk from the donor to the recipient. Liver Transpl 19:472–481

    Article  PubMed  Google Scholar 

  14. Demetris AJ, Kelly DM, Eghtesad B, Fontes P, Wallis Marsh J, Tom K et al (2006) Pathophysiologic observations and histopathologic recognition of the portal hyperperfusion or small-for-size syndrome. Am J Surg Pathol 30:986–993

    Article  PubMed  Google Scholar 

  15. Man K, Lo CM, Ng IO, Wong YC, Qin LF, Fan ST et al (2001) Liver transplantation in rats using small-for-size grafts: a study of hemodynamic and morphological changes. Arch Surg 136:280–285

    Article  CAS  PubMed  Google Scholar 

  16. Fondevila C, Hessheimer AJ, Taura P, Sanchez O, Calatayud D, de Riva N et al (2010) Portal hyperperfusion: mechanism of injury and stimulus for regeneration in porcine small-forsize transplantation. Liver Transpl 16:364–374

    Article  PubMed  Google Scholar 

  17. Asakura T, Ohkohchi N, Orii T, Koyamada N, Tsukamoto S, Sato M et al (2003) Portal vein pressure is the key for successful liver transplantation of an extremely small graft in the pig model. Transpl Int 16:376–382

    Article  PubMed  Google Scholar 

  18. Yagi S, Iida T, Hori T, Taniguchi K, Nagahama M, Isaji S et al (2012) Effect of portal haemodynamics on liver graft and intestinal mucosa after small-for-size liver transplantation in swine. Eur Surg Res 48:163–170

    Article  CAS  PubMed  Google Scholar 

  19. Troisi R, Cammu G, Militerno G, De Baerdemaeker L, Decruyenaere J, Hoste E et al (2003) Modulation of portal graft inflow: a necessity in adult living-donor liver transplantation? Ann Surg 237:429–436

    PubMed  PubMed Central  Google Scholar 

  20. Hori T, Yagi S, Iida T, Taniguchi K, Yamagiwa K, Yamamoto C et al (2007) Stability of cirrhotic systemic hemodynamics ensures sufficient splanchnic blood flow after living-donor liver transplantation in adult recipients with liver cirrhosis. World J Gastroenterol 13:5918–5925

    Article  PubMed  PubMed Central  Google Scholar 

  21. Ogura Y, Hori T, El Moghazy WM, Yoshizawa A, Oike F, Mori A et al (2010) Portal pressure <15 mm Hg is a key for successful adult living donor liver transplantation utilizing smaller grafts than before. Liver Transpl 16:718–728

    PubMed  Google Scholar 

  22. Ito T, Kiuchi T, Yamamoto H, Oike F, Ogura Y, Fujimoto Y et al (2003) Changes in portal venous pressure in the early phase after living donor liver transplantation: pathogenesis and clinical implications. Transplantation 75:1313–1317

    Article  PubMed  Google Scholar 

  23. Cheng YF, Huang TL, Chen TY, Concejero A, Tsang LL, Wang CC et al (2006) Liver graft-to-recipient spleen size ratio as a novel predictor of portal hyperperfusion syndrome in living donor liver transplantation. Am J Transplant 6:2994–2999

    Article  CAS  PubMed  Google Scholar 

  24. Troisi R, de Hemptinne B (2003) Clinical relevance of adapting portal vein flow in living donor liver transplantation in adult patients. Liver Transpl 9:S36–S41

    Article  PubMed  Google Scholar 

  25. Umeda Y, Yagi T, Sadamori H, Matsukawa H, Matsuda H, Shinoura S et al (2008) Effects of prophylactic splenic artery modulation on portal overperfusion and liver regeneration in small-for-size graft. Transplantation 86:673–680

    Article  PubMed  Google Scholar 

  26. Boillot O, Delafosse B, Mėhet I, Boucaud C, Pouyet M (2002) Small-for-size partial liver graft in an adult recipient: a new transplant technique. Lancet 359:406–407

    Article  PubMed  Google Scholar 

  27. Masetti M, Siniscalchi A, De Pietri L, Braglia V, Benedetto F, Di Cautero N et al (2004) Living donor liver transplantation with left liver graft. Am J Transplant 4:1713–1716

    Article  PubMed  Google Scholar 

  28. Takada Y, Ueda M, Ishikawa Y, Fujimoto Y, Miyauchi H, Ogura Y et al (2004) End-to-side portocaval shunting for a small-for-size graft in living donor liver transplantation. Liver Transpl 10:807–810

    Article  PubMed  Google Scholar 

  29. Troisi R, Ricciardi S, Smeets P, Petrovic M, Van Maele G, Colle I et al (2005) Effects of hemi-portocaval shunts for inflow modulation on the outcome of small-for-size grafts in living donor liver transplantation. Am J Transplant 5:1397–1404

    Article  PubMed  Google Scholar 

  30. Yamada T, Tanaka K, Uryuhara K, Ito K, Takada Y, Uemoto S (2008) Selective hemi-portocaval shunt based on portal vein pressure for small-for-size graft in adult living donor liver transplantation. Am J Transplant 8:847–853

    Article  CAS  PubMed  Google Scholar 

  31. Botha JF, Langnas AN, Campos BD, Grant WJ, Freise CE, Ascher NL et al (2010) Left lobe adult-to-adult living donor liver transplantation: small grafts and hemiportocaval shunts in the prevention of small-for-size syndrome. Liver Transpl 16:649–657

    Article  PubMed  Google Scholar 

  32. Takeda K, Morioka D, Kumamoto T, Matsuo K, Tanaka K, Endo I et al (2009) Survival case of ABO-incompatible liver transplantation complicated with severe preoperative infection and subsequent overwhelming postsplenectomy infection. Transplant Proc 41:3941–3944

    Article  CAS  PubMed  Google Scholar 

  33. Balci D, Taner B, Dayangac M, Akin B, Yaprak O, Duran C et al (2008) Splenic abscess after splenic artery ligation in living donor liver transplantation: a case report. Transplant Proc 40:1786–1788

    Article  CAS  PubMed  Google Scholar 

  34. Ishizaki Y, Kawasaki S, Sugo H, Yoshimoto J, Fujiwara N, Imamura H (2012) Left lobe adult-to-adult living donor liver transplantation: Should portal inflow modulation be added? Liver Transpl 18:305–314

    Article  PubMed  Google Scholar 

  35. Sugawara Y, Makuuchi M, Kaneko J, Kokudo N (2003) MELD score for selection of patients to receive a left liver graft. Transplantation 75:573–574

    Article  PubMed  Google Scholar 

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Correspondence to Naoya Yamada.

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Yamada, N., Sanada, Y., Hirata, Y. et al. The outcomes of pediatric living donor liver transplantation using small-for-size grafts: experience of a single institute. Pediatr Surg Int 32, 363–368 (2016). https://doi.org/10.1007/s00383-016-3859-4

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  • DOI: https://doi.org/10.1007/s00383-016-3859-4

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