• Tiffany Cho-Lam Wong, FungJames Y YJYYDepartment of Medicine, The University of Hong Kong, Hong Kong, China.Department of Medicine, Queen Mary Hospital, Hong Kong, China., Tracy Y S Cui, S L Sin, K W Ma, Brian W H She, ChanAlbert C YACYDepartment of Surgery, The University of Hong Kong, Hong Kong, China.Department of Surgery, Queen Mary Hospital, Hong Kong, China., ChokKenneth S HKSHDepartment of Surgery, The University of Hong Kong, Hong Kong, China.Department of Surgery, Queen Mary Hospital, Hong Kong, China., Jeff W C Dai, Tan-To Cheung, and Chung-Mau Lo.
• Department of Surgery, The University of Hong Kong, Hong Kong, China.
• Ann. Surg. 2021 Dec 1; 274 (6): e1260-e1268.

ObjectiveThe aim of this study was to determine the outcomes of living donor liver transplantation (LDLT) according to various graft-to-recipient weight ratio (GRWR).BackgroundThe standard GRWR in LDLT is >0.8%. Our center accepted predicted GRWR ≥0.6% in selected patients.MethodsData from patients who underwent LDLT from 2001 to 2017 were included. Patients were stratified according to actual GRWR (Group 1:GRWR ≤0.6%; Group 2: 0.6%0.8%).ResultsThere were 545 LDLT (group 1 = 39; group 2 = 159; group 3 = 347) performed. Pretransplant predicted GRWR showed good correlation to actual GRWR (R2 = 0.834) and these figures differed within a ± 10%margin (P = 0.034) using an equivalence test. There were more left lobe grafts in group 1 (33.3%) than group 2 (10.7%) and 3 (2.9%). Median donor age was <35 years and steatosis >10% was rare.There was no difference in postoperative complication, vascular and biliary complication rate between groups. Over one-fifth (20.5%) of group 1 patients required portal flow modulation (PFM) and was higher than group 2 (3.1%) and group 3 (4%) (P = 0.001). Twenty-six patients developed small-for-size syndrome (SFSS): 5 of 39 (12.8%) in group 1 and 21 of 159 (13.2%) in group 2 and none in group 3 (P < 0.001). There were 2 hospital mortalities; otherwise, the remaining patients [24/26 (92.3%)] survive with a functional liver graft. The 5-year graft survival rates were 85.4% versus 87.8% versus 84.7% for group 1, 2, and 3, respectively (P = 0.718). GRWR did not predict worse survivals in multivariable analysis.ConclusionsGraft size in LDLT can be lowered to 0.6% after careful recipient selection, with low incidence of SFSS and excellent outcomes. Accurate graft weight prediction, donor-recipient matching, meticulous surgical techniques, appropriate use of PFM, and vigilant perioperative care is important to the success of such approach.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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