Outcomes of adult patients adopting small-for-size grafts in living donor liver transplantation: A systematic review and meta-analysis
|
摘要
Background: Small-for-size graft(SFSG) has emerged as one of the very contentions in adult-to-adult living donor liver transplantation(LDLT) as a certain graft size is related to recipients' prognosis. Graftto-recipient weight ratio(GRWR) ≥0.8% was considered as a threshold to conduct LDLT. However, this also has been challenged over decades as a result of technique refinements. For a better understanding of SFSG in practice, we conducted this meta-analysis to compare the perioperative outcomes and long-term outcomes between patients adopting the grafts with a lower volume(GRWR < 0.8%, SFSG group) and sufficient volume(GRWR ≥ 0.8%, non-SFSG group) in adult-to-adult LDLT. Data sources: The studies comparing recipients adopting graft with a GRWR < 0.8% and ≥ 0.8% were searched by three authors independently in Pub Med, Web of Science, Embase, the Cochrane Library, MEDLINE and Google Scholar databases until September 2018 and data were analyzed by RevMan 5.3.5. Results: Sixteen studies with a total of 3272 subjects were included in this meta-analysis. In terms of small-for-size syndrome(SFSS), no significant difference was found in subjects enrolled after year 2010(before 2010, OR = 3.00, 95% CI: 1.69–5.35, P = 0.0002; after 2010, OR = 1.23, 95% CI: 0.79–1.90, P = 0.36; P for interaction: 0.02). There was no significant difference in operative duration, blood loss, cold ischemia time, biliary complications, acute rejection, postoperative bleeding, hospitalization time, perioperative mortality, and 1-, 3-and 5-year overall survival rates between two groups. Conclusions: This meta-analysis suggested that adopting SFSG in adult LDLT has comparable outcomes to those with non-SFSG counterparts since 2010.
Background: Small-for-size graft(SFSG) has emerged as one of the very contentions in adult-to-adult living donor liver transplantation(LDLT) as a certain graft size is related to recipients' prognosis. Graftto-recipient weight ratio(GRWR) ≥0.8% was considered as a threshold to conduct LDLT. However, this also has been challenged over decades as a result of technique refinements. For a better understanding of SFSG in practice, we conducted this meta-analysis to compare the perioperative outcomes and long-term outcomes between patients adopting the grafts with a lower volume(GRWR < 0.8%, SFSG group) and sufficient volume(GRWR ≥ 0.8%, non-SFSG group) in adult-to-adult LDLT. Data sources: The studies comparing recipients adopting graft with a GRWR < 0.8% and ≥ 0.8% were searched by three authors independently in Pub Med, Web of Science, Embase, the Cochrane Library, MEDLINE and Google Scholar databases until September 2018 and data were analyzed by RevMan 5.3.5. Results: Sixteen studies with a total of 3272 subjects were included in this meta-analysis. In terms of small-for-size syndrome(SFSS), no significant difference was found in subjects enrolled after year 2010(before 2010, OR = 3.00, 95% CI: 1.69–5.35, P = 0.0002; after 2010, OR = 1.23, 95% CI: 0.79–1.90, P = 0.36; P for interaction: 0.02). There was no significant difference in operative duration, blood loss, cold ischemia time, biliary complications, acute rejection, postoperative bleeding, hospitalization time, perioperative mortality, and 1-, 3-and 5-year overall survival rates between two groups. Conclusions: This meta-analysis suggested that adopting SFSG in adult LDLT has comparable outcomes to those with non-SFSG counterparts since 2010.
Background: Small-for-size graft(SFSG) has emerged as one of the very contentions in adult-to-adult living donor liver transplantation(LDLT) as a certain graft size is related to recipients' prognosis. Graftto-recipient weight ratio(GRWR) ≥0.8% was considered as a threshold to conduct LDLT. However, this also has been challenged over decades as a result of technique refinements. For a better understanding of SFSG in practice, we conducted this meta-analysis to compare the perioperative outcomes and long-term outcomes between patients adopting the grafts with a lower volume(GRWR < 0.8%, SFSG group) and sufficient volume(GRWR ≥ 0.8%, non-SFSG group) in adult-to-adult LDLT. Data sources: The studies comparing recipients adopting graft with a GRWR < 0.8% and ≥ 0.8% were searched by three authors independently in Pub Med, Web of Science, Embase, the Cochrane Library, MEDLINE and Google Scholar databases until September 2018 and data were analyzed by RevMan 5.3.5. Results: Sixteen studies with a total of 3272 subjects were included in this meta-analysis. In terms of small-for-size syndrome(SFSS), no significant difference was found in subjects enrolled after year 2010(before 2010, OR = 3.00, 95% CI: 1.69–5.35, P = 0.0002; after 2010, OR = 1.23, 95% CI: 0.79–1.90, P = 0.36; P for interaction: 0.02). There was no significant difference in operative duration, blood loss, cold ischemia time, biliary complications, acute rejection, postoperative bleeding, hospitalization time, perioperative mortality, and 1-, 3-and 5-year overall survival rates between two groups. Conclusions: This meta-analysis suggested that adopting SFSG in adult LDLT has comparable outcomes to those with non-SFSG counterparts since 2010.
引文
[1] Makuuchi M, Kosuge T, Takayama T, Yamazaki S, Kakazu T, Miyagawa S,et al. Surgery for small liver cancers. Semin Surg Oncol 1993;9:298-304.
[2] Marcos A. Right lobe living donor liver transplantation:a review. Liver Transpl2000;6:3-20.
[3] Kiuchi T, Kasahara M, Uryuhara K, Inomata Y, Uemoto S, Asonuma K, et al. Impact of graft size mismatching on graft prognosis in liver transplantation from living donors. Transplantation 1999;67:321-327.
[4] Tanaka K, Ogura Y."Small-for-size graft"and"small-for-size syndrome"in living donor liver transplantation. Yonsei Med J 2004;45:1089-1094.
[5] Hill MJ, Hughes M, Jie T, Cohen M, Lake J, Payne WD, et al. Graft weight/recipient weight ratio:how well does it predict outcome after partial liver transplants? Liver Transpl 2009;15:1056-1062.
[6] Klair T, Przybyszewski E, Samstein B. Outcomes of small-for-size grafts in adult living donor liver transplantation. Am J Transpl 2016;16:71-72.
[7] Nishizaki T, Ikegami T. Hiroshige S, Hashimoto K, Uchiyama H, Yoshizumi T,et al. Small graft for living donor liver transplantation. Ann Surg2001;233:575-580.
[8] Sethi P, Thillai M, Thankamonyamma BS, Mallick S, Gopalakrishnan U, Balakrishnan D, et al. Living donor liver transplantation using small-for-size grafts:does size really matter? J Clin Exp Hepatol 2018;8:125-131.
[9] Shimada M, Ijichi H, Yonemura Y, Harada N, Shiotani S, Ninomiya M, et al. Is graft size a major risk factor in living-donor adult liver transplantation?Transpl Int 2004;17:310-316.
[10] Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol2010;25:603-605.
[11] Luo D, Wan X, Liu J, Tong T. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res 2018;27:1785-1805.
[12] Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 2014; 14:135.
[13] Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005;5:13.
[14] Moon JI, Kwon CH, Joh JW, Jung GO, Choi GS, Park JB, et al. Safety of small-for-size grafts in adult-to-adult living donor liver transplantation using the right lobe. Liver Transpl 2010;16:864-869.
[15] Lee HH, Joh JW, Lee KW, Kim SJ, Lee DS, Park JH, et al. Small-for-size graft in adult living-donor liver transplantation. Transpl Proc 2004;36:2274-2276.
[16] Lee EC, Kim SH, Shim JR, Park SJ. Small-for-size grafts increase recurrence of hepatocellular carcinoma in liver transplantation beyond milan criteria. Liver Transpl 2018;24:35-43.
[17] Lee SD, Kim SH, Kim YK, Lee SA, Park SJ. Graft-to-recipient weight ratio lower to 0.7%is safe without portal pressure modulation in right-lobe living donor liver transplantation with favorable conditions. Hepatobiliary Pancreat Dis Int2014;13:18-24.
[18] Kaido T, Mori A, Ogura Y, Hata K, Yoshizawa A, lida T, et al. Lower limit of the graft-to-recipient weight ratio can be safely reduced to 0.6%in adult-to-adult living donor liver transplantation in combination with portal pressure control.Transpl Proc 2011;43:2391-2393.
[19] Selzner M, Kashfi A, Cattral MS, Selzner N, Greig PD, Lilly L, et al. A graft to body weight ratio less than 0.8 does not exclude adult-to-adult right-lobe living donor liver transplantation. Liver Transpl 2009;15:1776-1782.
[20] Chen PX, Yan LN, Wang WT. Outcome of patients undergoing right lobe living donor liver transplantation with small-for-size grafts. World J Gastroenterol2014;20:282-289.
[21] Hu Z, Zhong X, Zhou J, Xiang J, Li Z, Zhang M, et al. Smaller grafts do not imply early recurrence in recipients transplanted for hepatocellular carcinoma:a Chinese experience. Sci Rep 2016;6:26487.
[22] Vasavada B, Chen CL, Zakaria M. Using low graft/recipient's body weight ratio graft with portal flow modulation an effective way to prevent small-for-size syndrome in living-donor liver transplant:a retrospective analysis. Exp Clin Transpl 2014;12:437-442.
[23] Matsuyama T, Iida T, Masuda K, Harada S, Nakamura T, Koshino K, et al. Clinical outcome of adult living donor liver transplantation using small for size grafts. J Hepatobiliary Pancreat Sci 2017;24:A372.
[24] Gyoten K, Mizuno S, Tanemura A, Murata Y, Kishiwada M, Hamada T, et al. Impact of the regulation of portal venous pressure on the small-for-size graft in adult living donor liver transplantation. Am J Transpl 2010;10:101-102.
[25] Uemura T, Wada S, Kaido T, Mori A, Ogura Y, Yagi S, et al. How far can we lower graft-to-recipient weight ratio for living donor liver transplantation under modulation of portal venous pressure? Surgery 2016;159:1623-1630.
[26] Lei JY, Yan LN, Li B, Wen TF, Wang WT, Xu MQ, et al. Graft size alone should not affect donors selection and be used to predict the prognosis of recipients after living donor liver transplantation. Hepatogastroenterology2012;59:224-227.
[27] Ishizaki Y, Kawasaki S, Sugo H, Yoshimoto J, Fujiwara N, Imamura H. Left lobe adult-to-adult living donor liver transplantation:should portal inflow modulation be added? Liver Transpl 2012;18:305-314.
[28] Dahm F, Georgiev P, Clavien PA. Small-for-size syndrome after partial liver transplantation:definition, mechanisms of disease and clinical implications.Am J Transplant 2005;5:2605-2610.
[29] Troisi R, Praet M, de Hemptinne B. Small-for-size syndrome:what is the problem? Liver Transpl 2003;9:S1.
[30] Cho JY, Suh KS, Kwon CH, Yi NJ, Cho SY, Jang JJ, et al. The hepatic regeneration power of mild steatotic grafts is not impaired in living-donor liver transplantation. Liver Transpl 2005;11:210-217.
[31] Hori T, Ogura Y, Ogawa K, Kaido T, Segawa H, Okajima H, et al. How transplant surgeons can overcome the inevitable insufficiency of allograft size during adult living-donor liver transplantation:strategy for donor safety with a smaller-size graft and excellent recipient results. Clin Transpl 2012;26:E324-E334.
[32] Kelly DM, Demetris AJ, Fung JJ, Marcos A, Zhu Y, Subbotin V, et al. Porcine partial liver transplantation:a novel model of the"small-for-size"liver graft.Liver Transpl 2004;10:253-263.
[33] Man K, Lo CM, Ng IO, Wong YC, Qin LF, Fan ST, et al. Liver transplantation in rats using small-for-size grafts:a study of hemodynamic and morphological changes. Arch Surg 2001;136:280-285.
[34] Quintini C, Hirose K, Hashimoto K, Diago T, Aucejo F, Eghtesad B, et al."Splenic artery steal syndrome"is a misnomer:the cause is portal hyperperfusion, not arterial siphon. Liver Transpl 2008;14:374-379.
[35] Bell R, Pandanaboyana S, Upasani V, Prasad R. Impact of graft-to-recipient weight ratio on small-for-size syndrome following living donor liver transplantation. ANZ J Surg 2018;88:415-420.
[36] Umeda Y, Yagi T, Sadamori H, Matsukawa H, Matsuda H, Shinoura S, et al. Effects of prophylactic splenic artery modulation on portal overperfusion and liver regeneration in small-for-size graft. Transplantation 2008;86:673-680.
[2] Marcos A. Right lobe living donor liver transplantation:a review. Liver Transpl2000;6:3-20.
[3] Kiuchi T, Kasahara M, Uryuhara K, Inomata Y, Uemoto S, Asonuma K, et al. Impact of graft size mismatching on graft prognosis in liver transplantation from living donors. Transplantation 1999;67:321-327.
[4] Tanaka K, Ogura Y."Small-for-size graft"and"small-for-size syndrome"in living donor liver transplantation. Yonsei Med J 2004;45:1089-1094.
[5] Hill MJ, Hughes M, Jie T, Cohen M, Lake J, Payne WD, et al. Graft weight/recipient weight ratio:how well does it predict outcome after partial liver transplants? Liver Transpl 2009;15:1056-1062.
[6] Klair T, Przybyszewski E, Samstein B. Outcomes of small-for-size grafts in adult living donor liver transplantation. Am J Transpl 2016;16:71-72.
[7] Nishizaki T, Ikegami T. Hiroshige S, Hashimoto K, Uchiyama H, Yoshizumi T,et al. Small graft for living donor liver transplantation. Ann Surg2001;233:575-580.
[8] Sethi P, Thillai M, Thankamonyamma BS, Mallick S, Gopalakrishnan U, Balakrishnan D, et al. Living donor liver transplantation using small-for-size grafts:does size really matter? J Clin Exp Hepatol 2018;8:125-131.
[9] Shimada M, Ijichi H, Yonemura Y, Harada N, Shiotani S, Ninomiya M, et al. Is graft size a major risk factor in living-donor adult liver transplantation?Transpl Int 2004;17:310-316.
[10] Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol2010;25:603-605.
[11] Luo D, Wan X, Liu J, Tong T. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res 2018;27:1785-1805.
[12] Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 2014; 14:135.
[13] Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005;5:13.
[14] Moon JI, Kwon CH, Joh JW, Jung GO, Choi GS, Park JB, et al. Safety of small-for-size grafts in adult-to-adult living donor liver transplantation using the right lobe. Liver Transpl 2010;16:864-869.
[15] Lee HH, Joh JW, Lee KW, Kim SJ, Lee DS, Park JH, et al. Small-for-size graft in adult living-donor liver transplantation. Transpl Proc 2004;36:2274-2276.
[16] Lee EC, Kim SH, Shim JR, Park SJ. Small-for-size grafts increase recurrence of hepatocellular carcinoma in liver transplantation beyond milan criteria. Liver Transpl 2018;24:35-43.
[17] Lee SD, Kim SH, Kim YK, Lee SA, Park SJ. Graft-to-recipient weight ratio lower to 0.7%is safe without portal pressure modulation in right-lobe living donor liver transplantation with favorable conditions. Hepatobiliary Pancreat Dis Int2014;13:18-24.
[18] Kaido T, Mori A, Ogura Y, Hata K, Yoshizawa A, lida T, et al. Lower limit of the graft-to-recipient weight ratio can be safely reduced to 0.6%in adult-to-adult living donor liver transplantation in combination with portal pressure control.Transpl Proc 2011;43:2391-2393.
[19] Selzner M, Kashfi A, Cattral MS, Selzner N, Greig PD, Lilly L, et al. A graft to body weight ratio less than 0.8 does not exclude adult-to-adult right-lobe living donor liver transplantation. Liver Transpl 2009;15:1776-1782.
[20] Chen PX, Yan LN, Wang WT. Outcome of patients undergoing right lobe living donor liver transplantation with small-for-size grafts. World J Gastroenterol2014;20:282-289.
[21] Hu Z, Zhong X, Zhou J, Xiang J, Li Z, Zhang M, et al. Smaller grafts do not imply early recurrence in recipients transplanted for hepatocellular carcinoma:a Chinese experience. Sci Rep 2016;6:26487.
[22] Vasavada B, Chen CL, Zakaria M. Using low graft/recipient's body weight ratio graft with portal flow modulation an effective way to prevent small-for-size syndrome in living-donor liver transplant:a retrospective analysis. Exp Clin Transpl 2014;12:437-442.
[23] Matsuyama T, Iida T, Masuda K, Harada S, Nakamura T, Koshino K, et al. Clinical outcome of adult living donor liver transplantation using small for size grafts. J Hepatobiliary Pancreat Sci 2017;24:A372.
[24] Gyoten K, Mizuno S, Tanemura A, Murata Y, Kishiwada M, Hamada T, et al. Impact of the regulation of portal venous pressure on the small-for-size graft in adult living donor liver transplantation. Am J Transpl 2010;10:101-102.
[25] Uemura T, Wada S, Kaido T, Mori A, Ogura Y, Yagi S, et al. How far can we lower graft-to-recipient weight ratio for living donor liver transplantation under modulation of portal venous pressure? Surgery 2016;159:1623-1630.
[26] Lei JY, Yan LN, Li B, Wen TF, Wang WT, Xu MQ, et al. Graft size alone should not affect donors selection and be used to predict the prognosis of recipients after living donor liver transplantation. Hepatogastroenterology2012;59:224-227.
[27] Ishizaki Y, Kawasaki S, Sugo H, Yoshimoto J, Fujiwara N, Imamura H. Left lobe adult-to-adult living donor liver transplantation:should portal inflow modulation be added? Liver Transpl 2012;18:305-314.
[28] Dahm F, Georgiev P, Clavien PA. Small-for-size syndrome after partial liver transplantation:definition, mechanisms of disease and clinical implications.Am J Transplant 2005;5:2605-2610.
[29] Troisi R, Praet M, de Hemptinne B. Small-for-size syndrome:what is the problem? Liver Transpl 2003;9:S1.
[30] Cho JY, Suh KS, Kwon CH, Yi NJ, Cho SY, Jang JJ, et al. The hepatic regeneration power of mild steatotic grafts is not impaired in living-donor liver transplantation. Liver Transpl 2005;11:210-217.
[31] Hori T, Ogura Y, Ogawa K, Kaido T, Segawa H, Okajima H, et al. How transplant surgeons can overcome the inevitable insufficiency of allograft size during adult living-donor liver transplantation:strategy for donor safety with a smaller-size graft and excellent recipient results. Clin Transpl 2012;26:E324-E334.
[32] Kelly DM, Demetris AJ, Fung JJ, Marcos A, Zhu Y, Subbotin V, et al. Porcine partial liver transplantation:a novel model of the"small-for-size"liver graft.Liver Transpl 2004;10:253-263.
[33] Man K, Lo CM, Ng IO, Wong YC, Qin LF, Fan ST, et al. Liver transplantation in rats using small-for-size grafts:a study of hemodynamic and morphological changes. Arch Surg 2001;136:280-285.
[34] Quintini C, Hirose K, Hashimoto K, Diago T, Aucejo F, Eghtesad B, et al."Splenic artery steal syndrome"is a misnomer:the cause is portal hyperperfusion, not arterial siphon. Liver Transpl 2008;14:374-379.
[35] Bell R, Pandanaboyana S, Upasani V, Prasad R. Impact of graft-to-recipient weight ratio on small-for-size syndrome following living donor liver transplantation. ANZ J Surg 2018;88:415-420.
[36] Umeda Y, Yagi T, Sadamori H, Matsukawa H, Matsuda H, Shinoura S, et al. Effects of prophylactic splenic artery modulation on portal overperfusion and liver regeneration in small-for-size graft. Transplantation 2008;86:673-680.