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World Journal of Surgery

, Volume 32, Issue 8, pp 1722–1730 | Cite as

The Right Small-for-Size Graft Results in Better Outcomes than the Left Small-for-Size Graft in Adult-to-Adult Living Donor Liver Transplantation

  • Nam-Joon Yi
  • Kyung-Suk SuhEmail author
  • Yong Beom Cho
  • Hae Won Lee
  • Eung-Ho Cho
  • Jai Young Cho
  • Woo Young Shin
  • Joohyun Kim
  • Kuhn Uk Lee
Article

Abstract

Background

The recent outcome of adult-to-adult living donor liver transplantation (ALDLT) using small-for-size grafts (SFSGs; GRWR <0.8%) has been excellent after right grafts were exclusively used in large-volume ALDLT centers.

Methods

We compared the outcome of ALDLTs using 11 right SFSGs (group R) with that using 18 left SFSGs (group L) of our center. The dysfunction of graft was defined dysfunction as hyperbilirubinemia (>5 mg/dl), prolonged prothrombin time (>2 INR), or uncontrolled ascites (>1,000 ml/day) on 3 consecutive days in posttransplant 7 days, and the dysfunction score (DS; the sum of points given per each sign) of the graft was used to describe the SFSG dysfunction severity.

Results

The pretransplant recipient status was similar between the groups, but the 1-year mortality rate was 0% in group R and 33.3% (n = 6) in group L (p = 0.038). The ICU stay was longer in group L (20 days) than in group R (11 days; p = 0.004). Hyperbilirubinemia in group R vs. L was noted in 54.5% vs. 50%, prolonged prothrombin time in 18.2% vs. 50%, and uncontrolled ascites in 54.5% vs. 100%. The DS was lower in group R than in group L (1.3 vs. 2; p = 0.007). The DS was zero in four right liver recipients. On multivariate analysis, the only factor affecting DS was the graft side.

Conclusion

The clinical signs of SFSG dysfunction were less arduous and there was no 1-year mortality in cases in group R. Therefore, the right SFSG may be used for ALDLT in the future base on the transplant center’s experience.

Keywords

Live Donor Liver Transplantation Middle Hepatic Vein Graft Dysfunction Portal Venous Pressure Serum Total Bilirubin Level 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

The authors thank Seung Wook Hwang for his artistic contribution.

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Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  • Nam-Joon Yi
    • 1
  • Kyung-Suk Suh
    • 1
    Email author
  • Yong Beom Cho
    • 1
  • Hae Won Lee
    • 1
  • Eung-Ho Cho
    • 1
  • Jai Young Cho
    • 1
  • Woo Young Shin
    • 1
  • Joohyun Kim
    • 1
  • Kuhn Uk Lee
    • 1
  1. 1.Department of SurgerySeoul National University College of Medicine, Seoul National University HospitalChongno-guKorea

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