Canlı vericili karaciğer naklinde küçük boyutlu greft kullanımı: boyut önemli mi?

Amaç: Canlı vericili karaciğer naklinde greft ağırlığının alıcı ağırlığına (GRWR) oranının %0,8'den yüksek olması tercih edilir. GRWR'si %0,8'in üzerinde olan alıcılar ile küçük GRWR'si olan alıcıları nakil sonrası komplikasyonlar ve sonuçlar açısından karşılaştırmayı amaçladık. Gereç ve yöntem: Ocak 2017-Temmuz 2022 tarihleri arasında İstinye Üniversitesi Hastanesi Karaciğer Nakli Ünitesi'nde canlı vericili karaciğer nakli yapılan hastaların verileri incelendi. Çalışma grubu hastaları GRWR<0,8% (Grup 1), GRWR %0,8-1 (Grup 2) ve GRWR>%1 (Grup 3) olarak sınıflandırıldı ve klinik veriler, komplikasyonlar ve mortalite oranları açısından karşılaştırıldı. Bulgular: 220 canlı donörden alınan karaciğer nakli alıcıları dahil edildi. Ortalama alıcı yaşı 53,6 (18-79) idi. Grup 1 (n=29), Grup 2 (n=70) ve Grup 3 (n=121) arasındaki karşılaştırmalı analiz, safra kaçağı oranları ve hastanede kalış süresi (p=0,033, p<0,05) açısından anlamlı farklılıklar ortaya koydu. Safra kaçağı oranları Grup 1'de %7,4, Grup 2'de %6, Grup 3'te %0,8 idi. Safra kaçağı oranı Grup 3'te Grup 1 ve Grup 2'ye göre anlamlı derecede düşüktü (p=0,041, p<0,05). Hastanede kalış sürelerinin ortancaları grup 1, 2 ve 3'te 18 (7-40) gün, 15 (5-46) gün ve 16 (1-130) gündü (p=0,033). Diğer parametreler açısından, üç grup benzer sonuçlar verdi. Sonuç: Canlı vericili karaciğer nakli sonrası GRWR değerinin 0,8'den düşük olması hastanede kalış süresini uzatan bir faktör, GRWR değerinin 1'den büyük olması ise biliyer komplikasyon riskini azaltan bir faktör gibi görünse de, bu farklılıklar toplam komplikasyon, akut rejeksiyon ve hasta sağkalımı oranlarını etkilememektedir.

Anahtar Kelimeler:

Greft alıcı ağırlık oranı, karaciğer nakli, canlı vericili

Using small size grafts in live donor liver transplantation: is size important?

Purpose: In living donor liver transplantation, it is preferred that the ratio of the weight of the graft to the weight of the recipient (GRWR) be higher than 0.8%. We aimed to compare recipients with a GRWR greater than 0.8% and those with a small GRWR regarding post-transplant complications and outcomes. Materials and methods: Data of the patients who had undergone living donor liver transplant surgery in İstinye University Hospital Liver Transplant Unit between January 2017 and July 2022 were reviewed. The study group patients were classified as GRWR<0.8% (Group 1), GRWR 0.8-1% (Group 2), and GRWR>1% (Group 3) and compared regarding clinical data, complications, and mortality rates. Results: Liver transplant recipients from 220 living donors were included. The mean recipient age was 53.6 (18-79). The comparative analysis between Group 1 (n=29), Group 2 (n=70), and Group 3 (n=121) revealed significant differences concerning the rates of bile leak and the length of hospital stay (p=0.033, p<0.05). Bile leak rates were 7.4% in Group 1, 6% in Group 2, and 0.8% in Group 3. The bile leakage rate was significantly lower in Group 3 than in Groups 1 and 2 (p=0.041, p<0.05). The medians of hospitalization periods were 18 (7-40) days, 15 (5-46) days, and 16 (1-130) days in groups 1, 2, and 3. In addition, the median length of stay was higher in Group 1 than in groups 2 and 3 (p=0.033). In terms of other parameters, the three groups gave similar results. Conclusion: Although a GRWR value of lower than 0.8 seems as a factor causing prolonged hospital stay, and a GRWR value of higher than 1 seems to lower the risk of biliary complications after a live donor liver transplantation, these changes are not associated with the changes in total complication and acute rejection rates and patient survival.

Keywords:

Graft recipient weight ratio, liver transplantation, live donor,

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1. Sethi P, Thillai M, Thankamonyamma BS, et al. Living donor liver transplantation using small-for-size grafts: does size really matter? J Clin Exp Hepatol 2018;8:125-131. https://doi.org/10.1016/j.jceh.2017.06.004
2. Kiuchi T, Kasahara M, Uryuhara K, et al. Impact of graft size mismatching on graft prognosis in liver transplantation from living donors. Transplantation 1999;67:321-327. https://doi.org/10.1097/00007890-199901270-00024
3. Heaton N. Small-for-size liver syndrome after auxiliary and split liver transplantation: donor selection. Liver Transpl 2003;9:26-28. https://doi.org/10.1053/jlts.2003.50197
4. Kim SH. Successful living donor liver transplantation with a graft-to-recipient weight ratio of 0.41 without portal flow modulation: a case report. World J Clin Cases 2022;10:5414-5419. https://doi.org/10.12998/wjcc.v10.i16.5414
5. Hill MJ, Hughes M, Jie T, et al. Graft weight/recipient weight ratio: how well does it predict outcome after partial liver transplants? Liver Transpl 2009;15:1056-1062. https://doi.org/10.1002/lt.21846
6. Selvaggi G, Tzakis A. Surgical considerations in liver transplantation: small for size syndrome. Panminerva Med 2009;51:227-233.
7. Manzia TM, Lai Q, Hartog H, et al. Graft weight integration in the early allograft dysfunction formula improves the prediction of early graft loss after liver transplantation. Updates Surg 2022;74:1307-1316. https://doi.org/10.1007/s13304-022-01270-0
8. Addeo P, Naegel B, Terrone A, et al. Analysis of factors associated with discrepancies between predicted and observed liver weight in liver transplantation. Liver Int 2021;41:1379-1388. https://doi.org/10.1111/liv.14819
9. Martin P, DiMartini A, Feng S, Brown R Jr, Fallon M. Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Hepatology 2014;59:1144-1165. https://doi.org/10.1002/hep.26972
10. Duffy JP, Vardanian A, Benjamin E, et al. Liver transplantation criteria for hepatocellular carcinoma should be expanded: a 22-year experience with 467 patients at UCLA. Ann Surg 2007;246:502-511. https://doi.org/10.1097/SLA.0b013e318148c704
11. Wong TC, Fung JYY, Cui TYS, et al. The risk of going small: lowering GRWR and overcoming small-for-size syndrome in adult living donor liver transplantation. Ann Surg 2021;274:1260-1268. https://doi.org/10.1097/SLA.0000000000003824
12. Levesque E, Duclos J, Ciacio O, Adam R, Castaing D, Vibert E. Influence of larger graft weight to recipient weight on the post-liver transplantation course. Clin Transplant 2013;27:239-247. https://doi.org/10.1111/ctr.12059 13. Feng Y, Han Z, Wang X, Chen H, Li Y. Association of graft-to-recipient weight ratio with the prognosis following liver transplantation: a meta-analysis. J Gastrointest Surg 2020;24:1869-1879. https://doi.org/10.1007/s11605-020-04598-3
14. 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;18:206-213. https://doi.org/10.1016/j.hbpd.2019.03.007
15. Ma KW, Wong KHC, Chan ACY, et al. Impact of small-for-size liver grafts on medium-term and long-term graft survival in living donor liver transplantation: a meta-analysis. World J Gastroenterol 2019;25:5559-5568. https://doi.org/10.3748/wjg.v25.i36.5559
16. Miyagi S, Shono Y, Tokodai K, et al. Risks of living donor liver transplantation using small-for-size grafts. Transplant Proc 2020;52:1825-1828. https://doi.org/10.1016/j.transproceed.2020.01.136
17. 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. https://doi.org/10.1111/ans.14245