Conceptual changes in small-for-size graft and small-for-size syndrome in living donor liver transplantation
( Ikegami Toru ) - Kyushu University Department of Surgery and Science
김종만 ( Kim Jong-Man ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery
정동환 ( Jung Dong-Hwan ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
( Soejima Yuji ) - Shinshu University School of Medicine Department of Surgery
김동식 ( Kim Dong-Sik ) - Korea University College of Medicine Department of Surgery
조재원 ( Joh Jae-Won ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery
이승규 ( Lee Sung-Gyu ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
( Yoshizumi Tomoharu ) - Kyushu University Department of Surgery and Science
( Mori Masaki ) - Kyushu University Department of Surgery and Science
Abstract
Early series in living donor liver transplantation (LDLT) in adults demonstrated a lower safe limit of graft volume standard liver volume ratio 25%?45%. A subsequent worldwide large LDLT series proposed a 0.8 graft recipient weight ratio (GRWR) to define small-for-size graft (SFSG) in adult LDLT. Thereafter, researchers identified innate and inevitable factors including changes in liver volume during imaging studies and graft shrinkage due to perfusion solution. Although the definition of small-for-size syndrome (SFSS) advocated in the 2000s was mainly based on prolonged cholestasis and ascites output, the term SFSS was inadequate to describe clinical manifestations possibly caused by multiple factors. Thus, the term “early allograft dysfunction (EAD),” characterized by total bilirubin >10 mg/dL or coagulopathy with international normalized ratio >1.6 on day 7, has become prevalent to describe graft dysfunction including SFSS after LDLT. Although various efforts have been made to overcome EAD in LDLT, graft selection to maintain an expected GRWR >0.8 and full venous drainage, as well as inflow modulation using splenic artery ligation, have become standard in recent LDLT.
키워드
Living donor liver transplantation; Small-for-size graft; Small-for-size-syndrome; Early allograft dysfunction
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