Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct;36(10):e14630.
doi: 10.1111/ctr.14630.

The role of graft to recipient weight ratio on enhanced recovery of the recipient after living donor liver transplantation - A systematic review of the literature and expert panel recommendations

Madhukar S Patel  1 , Hiroto Egawa  2 , Yong Kyong Kwon  3 , Kenneth Siu Ho Chok  4 , Michael Spiro  5   6 , Dimitri Aristotle Raptis  6   7 , Vivek Vij  8 , Abhideep Chaudhary  9 , Yuri Genyk  3 ; ERAS4OLT.org Working Group
Collaborators, Affiliations

The role of graft to recipient weight ratio on enhanced recovery of the recipient after living donor liver transplantation - A systematic review of the literature and expert panel recommendations

Madhukar S Patel et al. Clin Transplant. 2022 Oct.

Abstract

Background: There continues to be debate about the lower limit of graft-to-recipient weight ratio (GRWR) for living donor liver transplant (LDLT).

Objectives: To identify the lower limit of GRWR compatible with enhanced recovery after living donor liver transplant and to provide international expert panel recommendations.

Data sources: Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central.

Methods: Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. Studies assessing how GRWR affects recipient outcomes such as small for size syndrome, other complications, patient and graft survival, and length of stay were included.

Protocol registration: CRD42021260794.

Results: Twenty articles were included in the qualitative synthesis, and all were retrospective observational studies. There was heterogeneity in the definition of study cohorts and key outcome measures such as small-for-size syndrome. Most studies lacked risk adjustment given limited single-center sample size. GRWR of ≥ .8% is associated with enhanced recovery. Recipients of grafts with GRWR < .8%, however, were found to have similar outcomes as those with ≥ .8% when appropriate consideration is made for portal flow modulation and recipient illness severity.

Conclusions: GRWR ≥ .8% is often compatible with enhanced recovery, but grafts < .8% can be used in selected LDLT recipients with optimal donor-recipient selection, surgical technique, and perioperative management (Quality of Evidence; Low | Grade of Recommendation; Strong).

Keywords: enhanced recovery; graft-to-recipient weight ratio; living donor; small for size.

PubMed Disclaimer

References

REFERENCES

    1. Lee HH, Joh JW, Lee KW, et al. Small-for-size graft in adult living-donor liver transplantation. Transplant Proc. 2004; 36(8): 2274-2276.
    1. Troisi R, Ricciardi S, Smeets P, et al. Effects of hemi-portocaval shunts for inflow modulation on the outcome of small-for-size grafts in living donor liver transplantation. Am J Transplant. 2005; 5(6): 1397-1404.
    1. Umeda Y, Yagi T, Sadamori H, et al. Effects of prophylactic splenic artery modulation on portal overperfusion and liver regeneration in small-for-size graft. Transplantation. 2008; 86(5): 673-680.
    1. Yi NJ, Suh KS, Cho YB, et al. The right small-for-size graft results in better outcomes than the left small-for-size graft in adult-to-adult living donor liver transplantation. World J Surg. 2008; 32(8): 1722-1730.
    1. Selzner M, Kashfi A, Cattral MS, et al. A graft to body weight ratio less than 0.8 does not exclude adult-to-adult right-lobe living donor liver transplantation. Liver Transplant. 2009; 15(12): 1776-1782.

Publication types

LinkOut - more resources