New prediction factors of small-for-size syndrome in living donor adult liver transplantation for chronic liver disease
Kensaku Sanefuji
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Search for more papers by this authorTomohiro Iguchi
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Search for more papers by this authorShigeru Ueda
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Search for more papers by this authorShigeyuki Nagata
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Search for more papers by this authorKeishi Sugimachi
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Search for more papers by this authorToru Ikegami
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Search for more papers by this authorTomonobu Gion
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Search for more papers by this authorYuji Soejima
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Search for more papers by this authorAkinobu Taketomi
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Search for more papers by this authorYoshihiko Maehara
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Search for more papers by this authorKensaku Sanefuji
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Search for more papers by this authorTomohiro Iguchi
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Search for more papers by this authorShigeru Ueda
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Search for more papers by this authorShigeyuki Nagata
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Search for more papers by this authorKeishi Sugimachi
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Search for more papers by this authorToru Ikegami
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Search for more papers by this authorTomonobu Gion
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Search for more papers by this authorYuji Soejima
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Search for more papers by this authorAkinobu Taketomi
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Search for more papers by this authorYoshihiko Maehara
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Search for more papers by this authorSummary
Small-for-size syndrome (SFSS), which is characterized by synthetic dysfunction and prolonged cholestasis, is a major cause of worse short-term prognoses after living donor adult liver transplantation (LDALT). However, the risks of SFSS remain unclear. The aim of this study was to clarify the risks of SFSS, which were analysed in 172 patients who underwent LDALT for chronic liver disease. Graft types included left lobe with caudate lobe graft (n = 110) and right lobe graft (n = 62). Thirty-four cases (24 with left lobe grafts and 10 with right lobe grafts) were determined as SFSS. SFSS developed even if the actual graft-to-recipient standard liver volume ratio was >40%. Logistic regression analysis revealed three independent factors associated with SFSS development in left and right lobe grafts: donor age, actual graft-to-recipient native liver volume ratio, and Child’s score. Donor age and actual graft-to-recipient native liver volume ratio may become predictive factors for SFSS development in left and right lobe grafts in patients undergoing LDALT.
References
- 1 Soejima Y, Taketomi A, Yoshizumi T, et al. Feasibility of left lobe living donor liver transplantation between adults: an 8-year, single-center experience of 107 cases. Am J Transplant 2006; 6: 1004.
- 2
Renz JKC,
Saggi B,
Emond J.
Outcomes of living donor liver transplantation. In: RKG Busuttil, ed. Transplantation of the Liver. 2nd edn. Philadelphia: Elsevier Saunders, 2005: 713–724.
10.1016/B978-0-7216-0118-2.50052-5 Google Scholar
- 3 Takemura N, Sugawara Y, Hashimoto T, et al. New hepatic vein reconstruction in left liver graft. Liver Transpl 2005; 11: 356.
- 4 Troisi R, Praet M, De Hemptinne B. Small-for-size syndrome: what is the problem? Liver Transpl 2003; 9: S1.
- 5 Ikegami T, Shiotani S, Ninomiya M, et al. Auxiliary partial orthotopic liver transplantation from living donors. Surgery 2002; 131: S205.
- 6 Shimada M, Ijichi H, Yonemura Y, et al. The impact of splenectomy or splenic artery ligation on the outcome of a living donor adult liver transplantation using a left lobe graft. Hepatogastroenterology 2004; 51: 625.
- 7 Shimada M, Ijichi H, Yonemura Y, et al. Is graft size a major risk factor in living-donor adult liver transplantation? Transpl Int 2004; 17: 310.
- 8 Soejima Y, Taketomi A, Ikegami T, et al. Living donor liver transplantation using dual grafts from two donors: a feasible option to overcome small-for-size graft problems? Am J Transplant 2008; 8: 887.
- 9 Ikegami T, Nishizaki T, Yanaga K, et al. Living-related auxiliary partial orthotopic liver transplantation for primary sclerosing chonangitis – subsequent removal of the native liver. Hepatogastroenterology 1999; 46: 2951.
- 10 Shimada M, Shiotani S, Ninomiya M, et al. Characteristics of liver grafts in living-donor adult liver transplantation: comparison between right- and left-lobe grafts. Arch Surg 2002; 137: 1174.
- 11 Nakamuta M, Morizono S, Soejima Y, et al. Short-term intensive treatment for donors with hepatic steatosis in living-donor liver transplantation. Transplantation 2005; 80: 608.
- 12 Yonemura Y, Taketomi A, Soejima Y, et al. Validity of preoperative volumetric analysis of congestion volume in living donor liver transplantation using three-dimensional computed tomography. Liver Transpl 2005; 11: 1556.
- 13 Hiroshige S, Shimada M, Harada N, et al. Accurate preoperative estimation of liver-graft volumetry using three-dimensional computed tomography. Transplantation 2003; 75: 1561.
- 14 Urata K, Kawasaki S, Matsunami H, et al. Calculation of child and adult standard liver volume for liver transplantation. Hepatology 1995; 21: 1317.
- 15 Ikegami T, Nishizaki T, Yanaga K, et al. Changes in the caudate lobe that is transplanted with extended left lobe liver graft from living donors. Surgery 2001; 129: 86.
- 16 Soejima Y, Shimada M, Suehiro T, Yoshizumi T, Kishikawa K, Maehara Y. Reconstruction of the middle hepatic vein tributaries using the recipient’s recanalized umbilical vein in right-lobe living-donor liver transplantation. Surgery 2006; 139: 442.
- 17 Kokudo N, Sugawara Y, Imamura H, Sano K, Makuuchi M. Sling suspension of the liver in donor operation: a gradual tape-repositioning technique. Transplantation 2003; 76: 803.
- 18 Yoshizumi T, Taketomi A, Soejima Y, et al. The beneficial role of simultaneous splenectomy in living donor liver transplantation in patients with small-for-size graft. Transpl Int 2008; 21: 833.
- 19 Ikegami T, Imura S, Arakawa Y, Shimada M. Transient portocaval shunt for a small-for-size graft in living donor liver transplantation. Liver Transpl 2008; 14: 262. Author reply 3.
- 20 Soejima Y, Shimada M, Suehiro T, et al. Outcome analysis in adult-to-adult living donor liver transplantation using the left lobe. Liver Transpl 2003; 9: 581.
- 21 Cho JY, Suh KS, Lee HW, et al. The clinical significance of early histological rejection with or without biochemical abnormality in adult living donor liver transplantation for hepatitis B virus related end stage liver disease. Transpl Int 2007; 20: 37.
- 22 Kiuchi T, Tanaka K, Ito T, et al. Small-for-size graft in living donor liver transplantation: how far should we go? Liver Transpl 2003; 9: S29.
- 23 Olthoff KM, Merion RM, Ghobrial RM, et al. Outcomes of 385 adult-to-adult living donor liver transplant recipients: a report from the A2ALL Consortium. Ann Surg 2005; 242: 314. Discussion 23–5.
- 24 Berenguer M, Prieto M, San Juan F, et al. Contribution of donor age to the recent decrease in patient survival among HCV-infected liver transplant recipients. Hepatology 2002; 36: 202.
- 25 Yoshizumi T, Taketomi A, Uchiyama H, et al. Graft size, donor age, and patient status are the indicators of early graft function after living donor liver transplantation. Liver Transpl 2008; 14: 1007.
- 26 Abt PL, Mange KC, Olthoff KM, Markmann JF, Reddy KR, Shaked A. Allograft survival following adult-to-adult living donor liver transplantation. Am J Transplant 2004; 4: 1302.
- 27 Nadalin S, Malago M, Radtke A, et al. Current trends in live liver donation. Transpl Int 2007; 20: 312.
- 28 Yoshizumi T, Taketomi A, Soejima Y, et al. Impact of donor age and recipient status on left-lobe graft for living donor adult liver transplantation. Transpl Int 2008; 21: 81.
- 29 Attia M, Silva MA, Mirza DF. The marginal liver donor – an update. Transpl Int 2008; 21: 713.
- 30 Schiano TD, Bodian C, Schwartz ME, Glajchen N, Min AD. Accuracy and significance of computed tomographic scan assessment of hepatic volume in patients undergoing liver transplantation. Transplantation 2000; 69: 545.
- 31 Emond JC, Renz JF, Ferrell LD, et al. Functional analysis of grafts from living donors. Implications for the treatment of older recipients. Ann Surg 1996; 224: 544. Discussion 52–4.
