Post Living Donor Liver Transplantation Small-for-size Syndrome: Definitions, Timelines, Biochemical, and Clinical Factors for Diagnosis: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference-Reference-Cited by-同舟云学术

Post Living Donor Liver Transplantation Small-for-size Syndrome: Definitions, Timelines, Biochemical, and Clinical Factors for Diagnosis: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference

Published:2023-09-25 Issue:10 Volume:107 Page:2226-2237
ISSN:0041-1337
Container-title:Transplantation
language:en
Short-container-title:

Author:

Kow Alfred Wei Chieh¹²,Liu Jiang³⁴,Patel Madhukar S.⁵,De Martin Eleonora⁶,Reddy Mettu Srinivas⁷,Soejima Yuji⁸,Syn Nicholas¹²,Watt Kymberly⁹,Xia Qiang¹⁰,Saraf Neeraj¹¹,Kamel Refaat¹²,Nasralla David¹³,McKenna Greg¹⁴,Srinvasan Parthi¹⁵,Elsabbagh Ahmed M.¹⁶,Pamecha Vinayendra¹⁷,Palaniappan Kumar¹⁸,Mas Valeria¹⁹,Tokat Yaman²⁰,Asthana Sonal²¹,Cherukuru Ramkiran²²,Egawa Hiroto²³,Lerut Jan²⁴,Broering Dieter²⁵,Berenguer Marina²⁶,Cattral Mark²⁷,Clavien Pierre-Alain²⁸,Chen Chao-Long²⁹,Shah Samir³⁰,Zhu Zhi-Jun³¹,Emond Jean³²,Ascher Nancy³³,Rammohan Ashwin²²,Bhangui Prashant¹¹,Rela Mohamed²²,Kim Dong-sik³⁴,Ikegami Toru³⁵,

Affiliation:

1. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, National University of Singapore, Singapore.

2. Liver Transplantation, National University Center for Organ Transplantation (NUCOT), National University Health System Singapore, Singapore.

3. Department of Surgery, Hepato-pancreato-biliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.

4. Department of Surgery, LKS Faculty of Medicine, HKU-Shenzhen Hospital, University of Hong Kong, Hong Kong/Special Administrative Region (SAR), China.

5. Division of Surgical Transplantation, University of Texas Southwestern Medical Center, Dallas, TX.

6. Department of Hepatology, APHP, Hospital Paul Brousse, Centre Hépato-Biliaire, INSERM Unit 1193, FHU Hepatinov, Villejuif, France.

7. Institute of Liver Disease and Transplantation, Gleneagles Global Health City, Chennai, India.

8. Department of Surgery, Shinshu University, Japan.

9. Division of Gastroenterology/Hepatology, Mayo Clinic, Rochester, MN.

10. Department of Surgery, Division of Liver Transplantation, Renji Hospital, Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine, China.

11. Institute of Liver Transplantation and Regenerative Medicine, Medanta–the Medicity, New Delhi, India.

12. Department of Surgery, Ain Shams University, Cairo, Egypt.

13. Department of HPB Surgery and Liver Transplantation, Royal Free London, Royal Free London NHS Foundation Trust, London, United Kingdom.

14. Department of Surgery, Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX.

15. Institute of Liver Studies, King’s College Hospital NHS Foundation Trust, London, United Kingdom.

16. Gastroenterology Surgical Center, Department of Surgery, Mansoura University, Mansoura, Egypt.

17. Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India.

18. The Institute of Liver Disease and Transplantation, Dr Rela Institute, and Medical Centre, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

19. Department of Surgery, School of Medicine, University of Maryland, Baltimore, MD.

20. International Liver Center, Acibadem Healthcare Hospitals, Turkey.

21. Department of Surgery, Integrated Liver Care Aster CMI Hospital, Bangalore, India.

22. The Institute of Liver Disease and Transplantation, Dr Rela Institute, and Medical Centre, Chennai, Tamil Nadu, India.

23. Hamamatsu Rosai Hospital, Hamamatsu, Shizuoka, Japan.

24. Pôle de chirurgie expérimentale et transplantation, Université Catholique De Louvain, Louvain, Belgium.

25. King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.

26. Hepatology and Liver Transplant Unit, Fundación Para La Investigación Del Hospital Universitario La Fe De La CCVV, IIS La Fe, Ciberehd, University of Valencia, Valencia, Spain.

27. Department of Surgery, University Health Network, Toronto General Hospital, Toronto, ON, Canada.

28. Department of Surgery, Universitets Hospital Zurich, Zurich, Switzerland.

29. Department of Surgery, Chang Gung Memorial Hospital Kaoshiung, Taiwan.

30. Institute of Liver Disease, HPB Surgery and Rransplant, Global Hospitals, Mumbai, India.

31. Department of HPB Surgery and Liver Transplantation, Beijing Friendship Hospital, Beijing, China.

32. Department of Surgery, Columbia University Medical Center, New York, NY.

33. Division of Transplant Surgery, University of California San Francisco, San Francisco, CA.

34. Department of Surgery, Korea University Medical Center, Anam Hospital, Seoul, South Korea.

35. Department of Surgery, Centennial Hall Kyushu University School of Medicine, Kyushu, Japan.

Abstract

Background. When a partial liver graft is unable to meet the demands of the recipient, a clinical phenomenon, small-for-size syndrome (SFSS), may ensue. Clear definition, diagnosis, and management are needed to optimize transplant outcomes. Methods. A Consensus Scientific committee (106 members from 21 countries) performed an extensive literature review on specific aspects of SFSS, recommendations underwent blinded review by an independent panel, and discussion/voting on the recommendations occurred at the Consensus Conference. Results. The ideal graft-to-recipient weight ratio of ≥0.8% (or graft volume standard liver volume ratio of ≥40%) is recommended. It is also recommended to measure portal pressure or portal blood flow during living donor liver transplantation and maintain a postreperfusion portal pressure of <15 mm Hg and/or portal blood flow of <250 mL/min/100 g graft weight to optimize outcomes. The typical time point to diagnose SFSS is the postoperative day 7 to facilitate treatment and intervention. An objective 3-grade stratification of severity for protocolized management of SFSS is proposed. Conclusions. The proposed grading system based on clinical and biochemical factors will help clinicians in the early identification of patients at risk of developing SFSS and institute timely therapeutic measures. The validity of this newly created grading system should be evaluated in future prospective studies.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Transplantation

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