Strategies to optimize donor safety with smaller grafts for adult-to-adult living donor liver transplantation

Current Opinion in Organ Transplantation
B Daniel Campos, Jean F Botha

Abstract

To describe our current understanding of adult-to-adult living donor liver transplantation (AA-LDLT) in terms of graft size. Improved outcomes of small liver graft with the use of portal vein pressure (PVP) modulation. AA-LDLT is viewed as a viable alternative to whole liver transplantation on the treatment of end-stage liver disease. Over the past two decades, right lobe AA-LDLT has been the standard because of concerns related to graft size. Small-for-size syndrome (SFSS) is an entity that presents in recipients of small grafts. It negatively affects patient and graft survival and recipients of grafts with a graft weight-to-recipient weight ratio (GW/RW) lower than 1.0 are at the highest risk. Over the last decade, our understanding of SFSS has identified PVP as a major determinant in the development of SFSS. Direct or indirect surgical PVP modulation has demonstrated a way to prevent the development of SFSS in recipients of small grafts and has improved the survival outcomes of small grafts. These improved outcomes coupled with concerns for donor safety have led to the renaissance of the use of left lobe grafts. Based on the current clinical data, the use of small grafts GW/RW greater than 0.6 is viewed as well tolerated whe...Continue Reading

References

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Jun 3, 2010·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Jean F Botha, B Daniel Campos
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Citations

Aug 22, 2013·World Journal of Gastroenterology : WJG·Yu-Liang TuJing-Wang Tan
Feb 28, 2014·World Journal of Gastroenterology : WJG·Xian-Qiang WangJia-Hong Dong
Jan 7, 2015·Hepatology Research : the Official Journal of the Japan Society of Hepatology·Tomohide HoriShinji Uemoto
Jan 3, 2014·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Jay A GrahamTomoaki Kato
Aug 12, 2016·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Altan AlimArzu Oezcelik
Jan 25, 2018·Experimental and Clinical Transplantation : Official Journal of the Middle East Society for Organ Transplantation·Murali AppukuttanViniyendra Pamecha

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