Is 0.6% reasonable as the minimum requirement of the graft-to-recipient weight ratio regardless of lobe selection in adult living-donor liver transplantation?

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Jiro Kusakabe ◽  
Shintaro Yagi ◽  
Kazunari Sasaki ◽  
Ryuji Uozumi ◽  
Hiroyasu Abe ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Weight Ratio ◽  
Donor Liver ◽  
Minimum Requirement ◽  
Donor Liver Transplantation

scholarly journals Portal flow modulation in living donor liver transplantation: review with a focus on splenectomy

Surgery Today ◽  
2019 ◽  
Vol 50 (1) ◽  
pp. 21-29 ◽  
Author(s):  
Tomoharu Yoshizumi ◽  
Masaki Mori
Keyword(s):  
Liver Transplantation ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Current Knowledge ◽  
Liver Volume ◽  
Weight Ratio ◽  
Portal Flow ◽  
Donor Liver ◽  
Flow Modulation ◽  
Donor Liver Transplantation

Abstract Small-for-size graft (SFSG) syndrome after living donor liver transplantation (LDLT) is the dysfunction of a small graft, characterized by coagulopathy, cholestasis, ascites, and encephalopathy. It is a serious complication of LDLT and usually triggered by excessive portal flow transmitted to the allograft in the postperfusion setting, resulting in sinusoidal congestion and hemorrhage. Portal overflow injures the liver directly through nutrient excess, endothelial activation, and sinusoidal shear stress, and indirectly through arterial vasoconstriction. These conditions may be attenuated with portal flow modulation. Attempts have been made to control excessive portal flow to the SFSG, including simultaneous splenectomy, splenic artery ligation, hemi-portocaval shunt, and pharmacological manipulation, with positive outcomes. Currently, a donor liver is considered a SFSG when the graft-to-recipient weight ratio is less than 0.8 or the ratio of the graft volume to the standard liver volume is less than 40%. A strategy for transplanting SFSG safely into recipients and avoiding extensive surgery in the living donor could effectively address the donor shortage. We review the literature and assess our current knowledge of and strategies for portal flow modulation in LDLT.

scholarly journals Renal Dysfunction after Living-Donor Liver Transplantation: Experience with 500 Cases

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Ehab E. Abdel-Khalek ◽  
Alrefaey K. Alrefaey ◽  
Amr M. Yassen ◽  
Ahmed Monier ◽  
Hesham M. Elgouhari ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Liver Transplantation ◽  
Kidney Disease ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Operative Time ◽  
Weight Ratio ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Negative Predictor

Introduction.The possible risk factors for chronic kidney disease in transplant recipients have not been thoroughly investigated after living-donor liver transplantation.Material and Methods.A retrospective cohort study of consecutive adults who underwent living-donor liver transplantation between May 2004 and October 2016, in a single center, was conducted. Kidney function was investigated successively for all the patients throughout the study period, with 12 months being the shortest follow-up. Postoperative renal dysfunction was defined in accordance with the Chronic Kidney Disease Epidemiology Collaboration criteria. The patients’ demographic data, preoperative and intraoperative parameters, and outcomes were recorded. A calcineurin inhibitor-based immunosuppressive regimen, either tacrolimus or cyclosporine, was used in all the patients.Results.Of the 413 patients included in the study, 33 (8%) who survived for ≥1 year experienced chronic kidney disease 1 year after living-donor liver transplantation. Twenty-seven variables were studied to compare between the patients with normal kidney functions and those who developed chronic kidney disease 1 year after living-donor liver transplantation. Univariate regression analysis for predicting the likelihood of chronic kidney disease at 1 year revealed that the following 4 variables were significant: operative time,P< 0.0005; intraoperative blood loss,P< 0.0005; preoperative renal impairment,P= 0.001; and graft-to-recipient weight ratio (as a negative predictor),P< 0.0005. In the multivariate regression analysis, only 2 variables remained as independent predictors of chronic kidney disease at 1 year, namely, operative time with a cutoff value of ≥714 minutes and graft-to-recipient weight ratio as a negative predictor with a cutoff value of <0.91.Conclusion.In this study, prolonged operative time and small graft-to-recipient weight ratio were independent predictors of chronic kidney disease at 1 year after living-donor liver transplantation.

scholarly journals Dysfunction in Patients With Small-for-Size Grafts After Living Donor Liver Transplantation

2015 ◽  
Vol 100 (3) ◽  
pp. 524-530 ◽  
Author(s):  
Shozo Mori ◽  
Min-Su Park ◽  
Hyeyoung Kim ◽  
Youngrok Choi ◽  
Geun Hong ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Characteristic Curve ◽  
Weight Ratio ◽  
Graft Dysfunction ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Small For Size ◽  
The Relationship

The relationship between postoperative percentage fall of platelet (PLT) counts and graft dysfunction after living donor liver transplantation (LDLT) in recipients with small-for-size (SFS) graft has not been fully evaluated. We retrospectively studied 50 adult-to-adult LDLT recipients with a graft-to-recipient weight ratio of &lt;0.8% between 1999 and 2011. Graft dysfunction was defined as the presence of hyperbilirubinemia, coagulopathy, or ascites on 3 consecutive days during the first postoperative week. Each clinical sign of dysfunction was assigned 1 point. Postoperative percentage fall in PLT counts, graft dysfunction score, and postoperative complications according to the Clavien-Dindo classification were investigated. Overall, 31 patients (62%) exhibited a PLT count fall of more than 50%, and 19 (38%) patients exhibited a PLT count fall of less than 50% at postoperative day (POD) 3. Receiver operating characteristic curve analysis indicated that at POD 3, the cutoff value of PLT count fall was 56% for a graft dysfunction score of 2 or 3 (sensitivity, 70%; specificity, 63.3%). Fourteen of 20 patients (70%) with a dysfunction score of 2 or 3 and 11 of 30 patients (37%) with a dysfunction score of 0 or 1 showed a fall in PLT count &gt;56% at POD 3 (P = 0.021). Grade 2 to 5 complications were more observed in patients with a dysfunction score of 2 or 3 than in patients with a dysfunction score of 0 or 1 (P &lt; 0.001). The fall of PLT count at POD 3 &gt;56% is an ominous sign that can predict the graft dysfunction after LDLT in recipients with SFS graft.

scholarly journals Graft-to-Recipient Weight Ratio Associated With Tacrolimus Metabolism Following Pediatric Living Donor Liver Transplantations

2019 ◽  
Vol 24 (2) ◽  
pp. 138-147
Author(s):  
Kensuke Shoji ◽  
Isao Miyairi ◽  
Eisuke Inoue ◽  
Akinari Fukuda ◽  
Seisuke Sakamoto ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Function ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Early Period ◽  
Weight Ratio ◽  
Pediatric Liver Transplantation ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Pediatric Liver

OBJECTIVES Tacrolimus (TAC) is an important immunosuppressant in liver transplantation. Since TAC is mainly metabolized by the liver enzymes CYP3A4 and 5, liver function is crucial for its pharmacokinetics (PK). Liver function is dynamic after liver transplantation; hence the PK of TAC metabolism after pediatric liver transplantation is not well understood. We aimed to investigate the time-dependent changes in TAC metabolism and to find factors influencing TAC PK after pediatric liver transplantation. METHODS We retrospectively reviewed the characteristics of the donors and recipients in pediatric living donor liver transplantation and used the TAC concentration-dose (CD) ratio as a surrogate marker of TAC metabolism. RESULTS Included were 326 patients with a median age of 13 months. After the liver transplantation, the CD ratio gradually decreased, then plateaued around day 21 to 28. A linear regression analysis demonstrated that a lower graft-to-recipient weight ratio (GRWR) and higher prothrombin time–international normalized ratio (PT-INR) were independently associated with a higher CD ratio in the early period after liver transplantation. However, association between GRWR and TAC CD ratio disappeared around 6 to 12 months after a liver transplantation possibly owing to graft regeneration. CONCLUSIONS Tacrolimus metabolism improved within the first month after liver transplantation, and the small graft size was associated with lower TAC metabolism in the early period after pediatric living donor liver transplantation.

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