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
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
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
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
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
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)
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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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