Abstract
Graft size-matching is one of the critical concerns in adult-to-adult living
donor liver transplantation (ATALDLT). In this study, we evaluated regeneration
of a small-for-size graft less than 50% of the standard liver volume (SLV). We
reviewed nine patients of united network of organ sharing (UNOS) status 2 or 3
who had undergone ATALDLT with a left lobe graft. For the comparison of liver
regeneration, 20 hepatectomized patients for biliary malignancy were selected as
non-transplant control group. In the ATALDLT group, graft size ranged from 30 to
49% of the SLV of recipients and their regeneration rates were 158%, 182%, 200%
and 185% after 1,2, 3 and 4 weeks following transplantation, respectively. In
the control group, preoperative volume of left lobe to whole liver volume ranged
between 40 and 54% and their regeneration rates were 145%, 156%, 163% and 177%
after 1,2, 3 and 4 weeks following extended right lobectomy, respectively. There
was no statistical difference in regeneration rates between two groups. In the
ATALDLT group, serum aspartate aminotransferase showed the median peak level of
198 IU/L on the first postoperative day and it was normalized within one week.
Recovery of bilirubin clearance lagged behind rapid volume regeneration by about
one week. Two patients died of sepsis. We postulate that the regenerative power
of small-for-size grafts from living donors is preserved, although time-lag
between volume regeneration and metabolic capability occurs in small-for-size
grafts, when the initial graft volume meets metabolic demands during the early
postoperative days.