Small graft for living donor liver transplantation

Objective To evaluate the impact of graft size on recipients in living dono r liver transplantation (LDLT) to establish a clinical guideline for the mi nimum requirement. Summary Background Data Although the minimum graft size required for LDLT h as been reported to be 30% to 40% of graft volume (GV)/standard liver volum e (SLV), the safety limit of the graft size was unknown. Methods A total of 33 cases of LDLT, excluding auxiliary transplantation, w ere reviewed with a minimum observation period of 4 months. The 33 patients were divided into three groups according to GV/SLV: medium-size graft grou p, small-size graft group, and extra-small graft group. The effect of GV/SL V on graft function, graft regeneration, and survival was evaluated. Results The overall patient survival rate was 94% at a mean follow-up of 15 months with a minimum observation period of 4 months, There were no statis tically significant differences in postoperative bilirubin clearance, alani ne aminotransferase, prothrombin time, and frequency of postoperative compl ications among the three groups. One week after transplantation, the regene ration rate (GV at 1 week/harvested GV) in the extra-small and small groups was significantly higher than that of the medium group. The graft and pati ent survival rates were both 100% in the extra-small group, 75% and 88% in the small group, and 90% and 95% in the medium group. Conclusions Small-for-size grafts less than 30% of SLV can be used with car eful intraoperative and postoperative management until the grafts regenerat e.