Skip to main content
Log in

Association of Graft-to-Recipient Weight Ratio with the Prognosis Following Liver Transplantation: a Meta-analysis

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Studies indicate that low graft-to-recipient weight ratio (GRWR) affect graft survival in adult-to-adult living donor liver transplantation. However, the potential role of GRWR in the prognosis of patients following living donor liver transplantation according to patient characteristics remains controversial. This study aimed to update the role of GRWR in patients following living donor liver transplantation.

Methods

PubMed, Embase, and Cochrane Library were comprehensively searched for studies comparing low GRWR (< 0.8%) with normal GRWR (≥ 0.8%) in the prognosis following living donor liver transplantation from inception to March 2019. The 1-, 3-, and 5-year summary survival rates, small-for-size syndrome (SFSS), perioperative mortality, biliary complications, postoperative bleeding, and acute rejection were calculated using the random-effects model.

Results

Eighteen studies comprising 4001 patients were included. Patients with low GRWR were associated with lower 1-year and 3-year survival rates compared to patients with normal GRWR, while no significant difference was found in the association of 5-year survival rate with low and normal GRWRs. Moreover, the risk of SFSS significantly increased in patients with low GRWR. Finally, no significant differences were observed in the association of low and normal GRWRs with the risk of perioperative mortality, biliary complications, postoperative bleeding, and acute rejection.

Conclusion

The results of this study indicated that low GRWR was associated with poor prognosis for patients following living donor liver transplantation, especially in terms of 1- and 3-year survival rates and SFSS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Broelsch CE, Emond JC, Whitington PF, Thistlethwaite JR, Baker AL, Lichtor JL. Application of reduced-size liver transplants as split grafts, auxiliary orthotopic grafts, and living related segmental transplants. Ann Surg 1990;212:368-375; discussion 375-367.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Lo CM, Fan ST, Liu CL, Wei WI, Lo RJ, Lai CL, Chan JK, Ng IO, Fung A, Wong J. Adult-to-adult living donor liver transplantation using extended right lobe grafts. Ann Surg 1997;226:261-269; discussion 269-270.

  3. Humar A, Ganesh S, Jorgensen D, Tevar A, Ganoza A, Molinari M, Hughes C. Adult living donor versus deceased donor liver transplant (LDLT versus DDLT) at a single center: time to change our paradigm for liver transplant. Annals Surg 2019; 270:444-451.

    Article  Google Scholar 

  4. Kiuchi T, Kasahara M, Uryuhara K, Inomata Y, Uemoto S, Asonuma K, Egawa H, Fujita S, Hayashi M, Tanaka K. Impact of graft size mismatching on graft prognosis in liver transplantation from living donors. Transplantation 1999;67:321-327.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  6. Hill MJ, Hughes M, Jie T, Cohen M, Lake J, Payne WD, Humar A. Graft weight/recipient weight ratio: how well does it predict outcome after partial liver transplants? Liver Transpl 2009;15:1056-1062.

    Article  PubMed  Google Scholar 

  7. Nishizaki T, Ikegami T, Hiroshige S, Hashimoto K, Uchiyama H, Yoshizumi T, Kishikawa K, Shimada M, Sugimachi K. Small graft for living donor liver transplantation. Ann Surg 2001;233:575-580.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Yagi S, Uemoto S. Small-for-size syndrome in living donor liver transplantation. Hepatobiliary Pancreat Dis Int 2012;11:570-576.

    Article  PubMed  Google Scholar 

  9. Umeda Y, Yagi T, Sadamori H, Matsukawa H, Matsuda H, Shinoura S, Mizuno K, Yoshida R, Iwamoto T, Satoh D, Tanaka N. Effects of prophylactic splenic artery modulation on portal overperfusion and liver regeneration in small-for-size graft. Transplantation 2008;86:673-680.

    Article  PubMed  Google Scholar 

  10. Ogura Y, Hori T, El Moghazy WM, Yoshizawa A, Oike F, Mori A, Kaido T, Takada Y, Uemoto S. Portal pressure <15 mm Hg is a key for successful adult living donor liver transplantation utilizing smaller grafts than before. Liver Transpl 2010;16:718-728.

    Article  PubMed  Google Scholar 

  11. Troisi R, Ricciardi S, Smeets P, Petrovic M, Van Maele G, Colle I, Van Vlierberghe H, de Hemptinne B. Effects of hemi-portocaval shunts for inflow modulation on the outcome of small-for-size grafts in living donor liver transplantation. Am J Transplant 2005;5:1397-1404.

    Article  PubMed  Google Scholar 

  12. Miller CM, Durand F, Heimbach JK, Kim-Schluger L, Lee SG, Lerut J, Lo CM, Quintini C, Pomfret EA. The international liver transplant society guideline on living liver donation. Transplantation 2016;100: 1238-1243.

    Article  PubMed  Google Scholar 

  13. Miller CM, Quintini C, Dhawan A, Durand F, Heimbach JK, Kim-Schluger HL, Kyrana E, Lee SG, Lerut J, Lo CM, Pomfret EA. The international liver transplantation society living donor liver transplant recipient guideline. Transplantation 2017;101:938–944

    Article  PubMed  Google Scholar 

  14. Wakade VA and Mathur SK. Donor Safety in Live-Related Liver Transplantation. Indian J Surg 2012;74: 118–126.

    Article  CAS  PubMed  Google Scholar 

  15. Uemura T, Wada S, Kaido T, Mori A, Ogura Y, Yagi S, Fujimoto Y, Ogawa K, Hata K, Yoshizawa A, Okajima H, Uemoto S. How far can we lower graft-to-recipient weight ratio for living donor liver transplantation under modulation of portal venous pressure? Surgery 2016;159: 1623-30.

    Article  PubMed  Google Scholar 

  16. Agarwal S, Selvakumar N, Rajasekhar K, Dey R, Verma S, Gupta S. Minimum absolute graft weight of 650 g predicts a good outcome in living donor liver transplant despite a graft recipient body weight ratio of less than 0.8. Clinical transplantation. 2019;33:e13705.

    Article  PubMed  Google Scholar 

  17. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Wells G, Shea B, O’Connell D. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hospital Research Institute 2009 http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.

    Google Scholar 

  19. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177-188.

    Article  CAS  PubMed  Google Scholar 

  20. Ades AE, Lu G, Higgins JP. The interpretation of random-effects meta-analysis in decision models. Med Decis Making 2005;25:646-654.

    Article  CAS  PubMed  Google Scholar 

  21. Deeks J, Higgins J, Altman D. Analyzing data and undertaking meta-analyses. In: Higgins J, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions 501 Oxford: The Cochrane Collaboration, 2008; chap 9.

    Google Scholar 

  22. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557-560.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Tobias A. Assessing the influence of a single study in meta-analysis. Stata Tech Bull 1999;47:15–17.

    Google Scholar 

  24. Altman DG, Bland JM. Interaction revisited: the difference between two estimates. BMJ 2003;326:219.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629-634.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994;50:1088-1101.

    Article  CAS  PubMed  Google Scholar 

  27. Lee HH, Joh JW, Lee KW, Kim SJ, Lee DS, Park JH, Choi SH, Heo JS, Hyon WS, Kwak MS, Lee SK. Small-for-size graft in adult living-donor liver transplantation. Transplant Proc 2004;36:2274-2276.

    Article  CAS  PubMed  Google Scholar 

  28. Selzner M, Kashfi A, Cattral MS, Selzner N, Greig PD, Lilly L, McGilvray ID, Therapondos G, Adcock LE, Ghanekar A, Levy GA, Renner EL, Grant DR. A graft to body weight ratio less than 0.8 does not exclude adult-to-adult right-lobe living donor liver transplantation. Liver Transpl 2009;15:1776-1782.

    Article  PubMed  Google Scholar 

  29. Moon JI, Kwon CH, Joh JW, Jung GO, Choi GS, Park JB, Kim JM, Shin M, Kim SJ, Lee SK. Safety of small-for-size grafts in adult-to-adult living donor liver transplantation using the right lobe. Liver Transpl 2010;16:864-869.

    Article  PubMed  Google Scholar 

  30. Gyoten K, Mizuno S, Tanemura A. Impact of the regulation of portal venous pressure on the small-for-size graft in adult living donor liver transplantation. Am J Transpl 2010;10:101-102.

    Google Scholar 

  31. Kaido T, Mori A, Ogura Y, Hata K, Yoshizawa A, Iida T, Yagi S, Uemoto S. Lower limit of the graft-to-recipient weight ratio can be safely reduced to 0.6% in adult-to-adult living donor liver transplantation in combination with portal pressure control. Transplant Proc 2011;43:2391-2393.

    Article  CAS  PubMed  Google Scholar 

  32. Lei JY, Yan LN, Li B, Wen TF, Wang WT, Xu MQ, Yang JY. Graft size alone should not affect donors selection and be used to predict the prognosis of recipients after living donor liver transplantation. Hepatogastroenterology 2012;59:224-227.

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  34. Lee SD, Kim SH, Kim YK, Lee SA, Park SJ. Graft-to-recipient weight ratio lower to 0.7% is safe without portal pressure modulation in right-lobe living donor liver transplantation with favorable conditions. Hepatobiliary Pancreat Dis Int 2014;13:18-24.

    Article  PubMed  Google Scholar 

  35. Vasavada B, Chen CL, Zakaria M. 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. Exp Clin Transplant 2014;12:437-442.

    PubMed  Google Scholar 

  36. Chen PX, Yan LN, Wang WT. Outcome of patients undergoing right lobe living donor liver transplantation with small-for-size grafts. World J Gastroenterol 2014;20:282-289.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Hu Z, Zhong X, Zhou J, Xiang J, Li Z, Zhang M, Wu J, Jiang W, Zheng S. Smaller grafts do not imply early recurrence in recipients transplanted for hepatocellular carcinoma: A Chinese experience. Sci Rep 2016;6:26487.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Klair T, Przybyszewski E, Samstein B. Outcomes of small-for-size grafts in adult living donor liver transplantation. Am J Transplant 2016;16:71-72.

    Google Scholar 

  39. Matsuyama T, Iida T, Masuda K. Clinical outcome of adult living donor liver transplantation using small for size grafts. J Hepatobiliary Pancreat Sci 2017;24:A372.

    Google Scholar 

  40. Sethi P, Thillai M, Thankamonyamma BS, Mallick S, Gopalakrishnan U, Balakrishnan D, Menon RN, Surendran S, Dhar P, Othiyil Vayoth S. Living Donor Liver Transplantation Using Small-for-Size Grafts: Does Size Really Matter? J Clin Exp Hepatol 2018;8:125-131.

    Article  PubMed  Google Scholar 

  41. Lee EC, Kim SH, Shim JR, Park SJ. Small-for-size grafts increase recurrence of hepatocellular carcinoma in liver transplantation beyond milan criteria. Liver Transpl 2018;24:35-43.

    Article  PubMed  Google Scholar 

  42. Goja S, Kumar Yadav S, Singh Soin A. Readdressing the Middle Hepatic Vein in Right Lobe Liver Donation: Triangle of Safety. Liver Transpl 2018;24:1363-1376.

    Article  PubMed  Google Scholar 

  43. Iesari S, Inostroza Nunez ME, Rico Juri JM, Ciccarelli O, Bonaccorsi-Riani E, Coubeau L, Laterre PF, Goffette P, De Reyck C, Lengele B, Gianello P, Lerut J. Adult-to-adult living-donor liver transplantation: The experience of the Universite catholique de Louvain. Hepatobiliary Pancreat Dis Int 2019;18:132-142.

    Article  PubMed  Google Scholar 

  44. Duvall S, Tweedie R. A nonparametric “trim and fill” method for assessing publication bias in meta-analysis. J Am Stat Assoc 2000;95:89–98.

    Google Scholar 

  45. Bell R, Pandanaboyana S, Upasani V, Prasad R. Impact of graft-to-recipient weight ratio on small-for-size syndrome following living donor liver transplantation. ANZ J Surg 2018;88:415-420.

    Article  PubMed  Google Scholar 

  46. Yan Y, Zheng DF, Pu JL, Wu ZJ. Outcomes of adult patients adopting small-for-size grafts in living donor liver transplantation: A systematic review and meta-analysis. Hepatobiliary Pancreat Dis Int 2019.

Download references

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Yanhu Feng or Yumin Li.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic Supplementary Material

ESM 1

(DOCX 27001 kb)

ESM 2

(DOCX 61 kb)

ESM 3

(DOCX 35762 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Feng, Y., Han, Z., Wang, X. et al. Association of Graft-to-Recipient Weight Ratio with the Prognosis Following Liver Transplantation: a Meta-analysis. J Gastrointest Surg 24, 1869–1879 (2020). https://doi.org/10.1007/s11605-020-04598-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-020-04598-3

Keywords

Navigation