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Purpose <p>To investigate the interaction between graft-to-recipient weight ratio (GRWR) and portal venous hemodynamics (PVH), with a net impact on the perioperative outcomes of living donor liver transplantation (LDLT).</p> Methods <p>We analyzed, retrospectively, adult LDLT recipients divided into three groups according to their GRWR: Group 1, &gt; 1.0% (n = 124); Group 2, 0.8 ~ 1.0% (n = 70); and Group 3, &lt; 0.8% (n = 31).</p> Results <p>The intraoperative PVH parameters did not differ significantly among the groups, but Group 3 had the highest number of patients needing portal inflow modulation to achieve optimal final portal pressure. Group 3 was also more prone to delayed recovery of liver function, a higher incidence of posttransplant kidney injury necessitating dialysis (16.1% vs. 3.2% for Group 1 and 4.3% for Group 2, p = 0.015) and a higher incidence of liver graft loss within 3&#xa0;months post-LDLT (22.6% vs. 7.3% for Group 1 and 4.3% for Group 2, p = 0.007). Logistic regression analysis revealed that extremely small liver grafts (GRWR &lt; 0.7%) were the most significant risk factor for early graft loss (HR: 16.951, 95% CI: 3.961 ~ 72.535). Survival analysis revealed comparable outcomes between patients who received liver grafts with a GRWR of 0.7 ~ 0.8% and those who received liver grafts with a GRWR &gt; 0.8%. Patients with extremely small liver grafts had significantly lower graft survival rates (1-month, 3-months, and 1-year post-LDLT, of 66.7%, 50.0%, and 50.0%, respectively (p &lt; 0.01).</p> Conclusion <p>Under intraoperative PVH monitoring, the accepted GRWR in LDLT could be extended to 0.7%, but a GRWR &lt; 0.7% remains a risk factor for early graft loss.</p>

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A graft-to-recipient weight ratio of less than 0.7% under portal venous hemodynamics monitoring is a risk factor for early graft loss after living donor liver transplantation

  • 期刊论文

  • 发表日期：

    2025年7月11日

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  • Niang-Cheng Lin,
  • Cheng-Yen Chen,
  • Hao-Jan Lei,
  • Hsin-Lin Tsai,
  • Yi-Fan Tsou,
  • Fang-Cheng Kuo,
  • Meng-Hsuan Chung,
  • Cheng-Yuan Hsia,
  • Che-Chuan Loong,
  • Shu-Cheng Chou,
  • Shen-Chih Wang,
  • Chinsu Liu

摘要

Purpose

To investigate the interaction between graft-to-recipient weight ratio (GRWR) and portal venous hemodynamics (PVH), with a net impact on the perioperative outcomes of living donor liver transplantation (LDLT).

Methods

We analyzed, retrospectively, adult LDLT recipients divided into three groups according to their GRWR: Group 1, > 1.0% (n = 124); Group 2, 0.8 ~ 1.0% (n = 70); and Group 3, < 0.8% (n = 31).

Results

The intraoperative PVH parameters did not differ significantly among the groups, but Group 3 had the highest number of patients needing portal inflow modulation to achieve optimal final portal pressure. Group 3 was also more prone to delayed recovery of liver function, a higher incidence of posttransplant kidney injury necessitating dialysis (16.1% vs. 3.2% for Group 1 and 4.3% for Group 2, p = 0.015) and a higher incidence of liver graft loss within 3 months post-LDLT (22.6% vs. 7.3% for Group 1 and 4.3% for Group 2, p = 0.007). Logistic regression analysis revealed that extremely small liver grafts (GRWR < 0.7%) were the most significant risk factor for early graft loss (HR: 16.951, 95% CI: 3.961 ~ 72.535). Survival analysis revealed comparable outcomes between patients who received liver grafts with a GRWR of 0.7 ~ 0.8% and those who received liver grafts with a GRWR > 0.8%. Patients with extremely small liver grafts had significantly lower graft survival rates (1-month, 3-months, and 1-year post-LDLT, of 66.7%, 50.0%, and 50.0%, respectively (p < 0.01).

Conclusion

Under intraoperative PVH monitoring, the accepted GRWR in LDLT could be extended to 0.7%, but a GRWR < 0.7% remains a risk factor for early graft loss.