HOBOKEN, NJ -- October 29, 2009 -- A study published in the November issue of Liver Transplantation shows that left side grafting has lower risk to donors compared with grafts taken from the right lobe, and it appears to be the procedure of choice for adult-to-adult living donor liver transplantation (LDLT).
Researchers also found that graft size was not the only cause behind small-for-size graft syndrome, a severe complication resulting in organ malfunction and transplant failure.
For the study, Toshihiko Ikegami, MD, Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, and colleagues performed LDLTs on 120 adult patients through October 2007.
Patients were divided into 2 groups: group S consisted of 33 patients who received liver grafts < 35% of their standard liver volume (SLV), and group L consisted of 87 patients who received liver grafts >= 35% of their SLV.
Results showed the 1- and 5-year survival rates in group S were 80.7% and 64.2% respectively; and in group L 90.8% and 84.9%, with no significant difference between groups.
Between 1 and 5 years after LDLT, 7 patients died with causes of death including cerebral infarction, recurrence of liver cancer, uterine cancer, and sepsis. ôThese deaths occurred in patients with good liver function who had resumed their normal lives,ö commented Dr. Ikegami. ôThe causes of death were not related to insufficient graft size.ö
Past studies have recommended a graft volume to recipient standard liver volume (GV/SLV) ratio of >40% and a graft-to-recipient weight ratio (GRWR) of >= 0.8% to achieve good graft and recipient survival rates.
In the current study patients in group S had a good survival rate, despite a GV/SLV ratio below 35% and a GRWR not exceeding 0.8%. Dr. Ikegami points out, ôOur research shows small graft size does not appear to be the only cause of small-for-size graft syndrome. The prognosis of recipients with liver grafts < 35% of their SLV is comparable to that of recipients with larger grafts.ö
According to the U.S. Department of Health and Human Services, 3,549 deceased donor and 249 LDLTs (5%) were performed in 2008. In Japan, 99% of all liver transplantations use living donors. The authors speculate that the lower percentage of LDLTs in the U.S. could be attributed to a highly publicised donor death in 2002 and that it is conceivable that the next donor death in Japan could lead to a similar resistance in that country. ôWe feel that left side grafts should be used more frequently in adult-to-adult LDLT, considering the lower risk to donors compared to right lobe grafts,ö recommended Dr. Ikegami.
SOURCE: Wiley Blackwell
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