• Susumu Eguchi, Koji Umeshita, Yuji Soejima, Hidetoshi Eguchi, Hiroto Egawa, Takumi Fukumoto, Hironori Haga, Kiyoshi Hasegawa, Mureo Kasahara, Hiroaki Nagano, Yasutsugu Takada, Katsutoshi Tokushige, Yoshihide Ueda, Satoshi Mochida, Hajime Matsushima, Tomohiko Adachi, Hideki Ohdan, and Japanese Liver Transplantation Society.
• Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
• Ann. Surg. 2024 Jan 1; 279 (1): 9410394-103.

ObjectiveTo analyze 10,000 cases of living donor liver transplantation (LDLT) recipient data to elucidate outcomes with special reference to the graft-versus-recipient weight ratio (GRWR), based on the Japanese Liver Transplantation Society (JLTS) registry.BackgroundThe JLTS registry has been accurate and complete in characterizing and following trends in patient characteristics and survival of all patients with LDLT.MethodsBetween November 1989 and August 2021, 10,000 patients underwent LDLT in Japan. The procedures performed during the study period included pediatric liver transplantation (age <18 years, n = 3572) and adult liver transplantation (age ≥18 years, n=6428). Factors related to patient survival (PS) and graft survival (GS) were also analyzed.ResultsThe GRWR was <0.7, 0.7 to <0.8, 0.8 to <3, 3 to <5, and ≥5 in 0.2%, 2.0%, 61.8%, 31.8%, and 2.6% of pediatric patients and <0.6, 0.6 to <0.7, 0.7 to <0.8, and ≥0.8 in 8.0%, 12.7%, 17.7%, and 61.5% of adult patients, respectively. Among pediatric recipients, the PS rate up to 5 years was significantly better in cases with a GRWR ≤5 than in those with a GRWR >5. When the GRWR and donor age were combined, among adult recipients 50 to 60 years old, the early PS and GS up to 5 years were significantly better in cases with a GRWR ≥0.7, than in those with a GRWR <0.7. (P = 0.02). In adults, a multivariate analysis showed that GRWR <0.6, transplant era (<2011), donor age (>60 years), recipient age (>60 years), model for end-stage liver disease score (≥20), and center volume (<10) were significant prognostic factors for long-term PS.ConclusionAlthough a satisfactory long-term PS and GS, especially in the recent era (2011-2021), was achieved in the JLTS series, a GRWR ≥5 in pediatric cases and relatively old donors with a GRWR <0.7 in adult cases should be managed with caution.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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