Outcomes of small-size graft in highly urgent living donor liver transplantation: Korean national data

Abstract

Background: The major concern for living donor liver transplantation (LDLT) is the selection of donor graft size because small grafts are often unable to meet metabolic demands or fail to function after implantation in highly urgent LDLT (HU-LDLT). We aim to compare the outcomes between the small graft volume group (graft-to-recipient weight ratio, GRWR <0.8%) and the non-small graft volume group (GRWR >= 0.8%) in the national data of HU-LDLT cases in Korea. Methods: We conducted a retrospective analysis of Korean Network of Organ Sharing (KONOS) data involving consecutive HU-LDLT patients between 2017 and 2021. Results: The proportion of the small graft group (GRWR <0.8%) was 7.6% (n=30). The overall survival and graft survival in the small-graft group were inferior to those in the non-small graft group (P=0.03 and P=0.004, respectively) despite there being no significant differences in intensive care unit (ICU) stay in the post-transplant period, postoperative complications, hospitalization, and in-hospital mortality between the groups. Long ICU stays in the post-transplant period and the small graft group were predisposed to mortality and graft failure in multivariate analysis. Conclusions: The present study suggested that the use of small-size grafts in HU-LDLT patients requires careful living liver donor selection regarding the interaction between GRWR and preoperative patient severity.