Minimum graft size for successful living donor liver transplantation

Background. The extension of living donor liver transplantation to adult re cipients is limited by the adequacy of the size of the graft. We evaluate t he effect of the graft size on the survival of the recipient in order to es tablish a clinical guide for the minimum requirement. Methods. The clinical records of 14 adults and 11 children (body weight 6.1 -100 kg) who underwent living donor liver transplantation for chronic or ac ute liver failure were reviewed. The effect of the graft weight ratio (graf t weight divided by standard liver weight of recipient) on graft function a nd survival was studied. Results. The graft weight ratio ranged from 31 to 203%. The overall graft a nd patient survival rates were 84% at a median follow-up of 29 months. The survival rate was 95% for recipients with a graft weight ratio >40%, and 40 % only for those with a ratio less than or equal to 40% (P=0.016). It was 8 8% (7/8) when the ratio was >100%, 100% (5/5) when the ratio was 71 to 100% , 100% (7/7) when the ratio was 41 to 70%, and 40% (2/5) only when the rati o was less than or equal to 40%. When the graft weight ratio was less than or equal to 40%, early graft dysfunction was evident and contributed to the causes of death in three patients. Conclusions. Preoperative computed tomographic measurement of liver size of a living donor is essential. A graft that represented 40% or less of the r ecipient's standard liver weight should be regarded as a marginal graft wit h a lower success rate.