Journal of hepato-biliary-pancreatic sciences · 2011
Body surface area index predicts outcome in orthotopic liver transplantation.
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Fukazawa Kyota, Nishida Seigo, Volsky Alex, Tzakis Andreas G, Pretto Ernesto A
Аннотация
BACKGROUND/PURPOSE: In living donor liver transplantation (LDLT), matching of liver volume between donor and recipient is critical to the success of the procedure; mismatch can result in 'small- or large-for-size syndrome'. In orthotopic liver transplantation (OLT), matching criteria are less stringent and non-uniform. We sought to determine whether a new parameter, the ratio of donor to recipient body surface area (BSAi), is predictive of size mismatch and/or post-transplant morbidity or mortality.
METHODS: We reviewed data on 1228 OLT recipients and stratified this data according to three categories: small-for-size (BSAi <0.6), control (BSAi = 0.6-1.4), and large-for-size (BSAi >1.4) donors.
RESULTS: We found that: (1) matching of grafts at the upper and lower extremes of BSAi had significantly reduced graft survival; (2) matches with lower BSAi sustained a less severe form of intraoperative post-reperfusion syndrome, and the incidence of hepatic artery thrombosis was high postoperatively in these grafts; (3) BSAi and donor age correlated well with the severity of intraoperative post-reperfusion hypotension; and (4) small-for-size (BSAi <0.6) and large-for-size (BSAi >1.4) grafts, as well as preoperative total bilirubin, were significant risk factors for decreased graft survival.
CONCLUSION: We conclude that the BSAi can predict clinically significant size mismatch and adverse outcomes in cadaveric whole OLT.
METHODS: We reviewed data on 1228 OLT recipients and stratified this data according to three categories: small-for-size (BSAi <0.6), control (BSAi = 0.6-1.4), and large-for-size (BSAi >1.4) donors.
RESULTS: We found that: (1) matching of grafts at the upper and lower extremes of BSAi had significantly reduced graft survival; (2) matches with lower BSAi sustained a less severe form of intraoperative post-reperfusion syndrome, and the incidence of hepatic artery thrombosis was high postoperatively in these grafts; (3) BSAi and donor age correlated well with the severity of intraoperative post-reperfusion hypotension; and (4) small-for-size (BSAi <0.6) and large-for-size (BSAi >1.4) grafts, as well as preoperative total bilirubin, were significant risk factors for decreased graft survival.
CONCLUSION: We conclude that the BSAi can predict clinically significant size mismatch and adverse outcomes in cadaveric whole OLT.