Outcome of Using Small-For-Size Grafts in Living Donor Liver Transplantation Recipients with High Model for End-Stage Liver Disease Scores: A Single Center Experience

Aims: To evaluate the impact of small-for-size grafts (SFSG) in adult-to-adult living donor liver transplantation (AALDLT) on outcomes of recipients with different model for end-stage liver disease (MELD) score in a single liver transplant center. Materials and Methods: Clinical data of 118 patients underwent right-lobe AALDLT from January 2004 to December 2011 were retrospectively analyzed, Patients were divided into Group L (MELD score≤25) and Group H (MELD score > 25) according to MELD score. The patients were further stratified into Group LS (MELD score≤25, GBWR 25, GBWR 25, GBWR≥0.8%) to investigate the impact of graft size on recipients’ complications and outcomes. Pre-operative characteristics, post-operative complications graded by the Clavien score and patient survival were analyzed. Results: MELD scores between the two groups were significant different (12.4±4.9 vs 34.5±7.5, P=0.026). There was no significant difference in preoperative demographic data as well as postoperative liver function. Complication rate, length of ICU and hospital stay, graft loss, and mortality were similar in both groups. The 1- and 3- year survival were similar between group H and group L. When recipients were further stratified into group LS, LN, HS, and HN, no significant difference was found among groups in 1- and 3- year survival rate. In multivariate analysis, HCC was not a predictor for long term survival. Conclusion: Our single institution experience demonstrates that it is safe to use SFSGs in high pre-MELD score recipients with the improvement of intensive care and the selection of listing criteria.