Detailed Abstract
[Liver Best Oral Presentation - Liver (Transplantation)]
[LV BO-S2] Clinical Significance of Grade a Small-for-Size Syndrome after Living-Donor Liver Transplantation Using the New Definition of Diagnostic Criteria: an International Multicenter Study
Hye-Sung JO 1, Dong-Sik KIM 1, Vasanthakumar GUNASEKARAN 2, Jagadeesh KRISHNAMURTHY 3, Takeo TOSHIMA 4, Ryugen TAKAHASHI 5, Jae-Yoon KIM 6, Sathish Kumar KRISHNAN 7, Shinya OKUMURA 8, Takanobu HARA 9, Kazuya HIRUKAWA 10, Koichiro HARUKI 11, Robert C. MINNEE 12, Toru IKEGAMI 11, Kwang-Woong LEE 6
1 Surgery, Korea University Anam Hospita, REPUBLIC OF KOREA, 2 HPB Surgery And Liver Transplantation, Dr. Rela Institute And Medical Centre, INDIA, 3 Liver Transplant And HPB Surgeries, Max Super Speciality Hospital, INDIA, 4 Surgery And Science, Kyushu University Hospital, JAPAN, 5 Artificial Organ And Transplantation Surgery, University of Tokyo, JAPAN, 6 Surgery, Seoul National University Hospital, REPUBLIC OF KOREA, 7 HPB And Liver Transplantation, Gleneagles Global Hospital, INDIA, 8 Surgery, Kyoto University, JAPAN, 9 Surgery, Nagasaki University Graduate School of Biomedical Sciences, JAPAN, 10 Pediatric Surgery And Transplantation, Kumamoto University Hospital, JAPAN, 11 Surgery, Jikei University Daisan Hospital, JAPAN, 12 Surgery, Erasmus Medical Center, NETHERLANDS
Background : New diagnostic criteria were recently established to classify SFSS (small-for-size syndrome) after living-donor liver transplantation (LDLT) into three groups based on its severity, but its clinical significance needs to be validated. This study aimed to evaluate the clinical impact of grade A SFSS and identify risk factors for survival through subgroup analysis.
Methods : We collected data from 406 patients diagnosed with SFSS grade A after LDLT between 2018 and 2022 from 12 hospitals in the International Living Donor Liver Transplantation Group. Survival data were also collected from 858 non-SFSS patients. After exclusion, 363 patients comprised 55 (15.2%) in the up-trend group, 251 (69.1%) in the down-trend group, and 57 (15.7%) in the ascites group according to the level and trend of total bilirubin on postoperative day 7 and 14.
Results : There was no difference in survival between SFSS grade A and non-SFSS patients (P=0.152). The up-trend group showed higher 30-day and 90-day mortality than the down-trend and ascites groups (P=0.076 and P=0.030, respectively). The 1-year survival rate significantly differed between the groups (88.8% vs. 93.1% vs. 98.2%, P=0.005). Independent risk factors for survival were up-trend of total bilirubin, recipient age (≥65), MELD score (≥30), and ABO incompatibility. Patients with two or more risk factors had worse survival rates compared to others (P<0.001).
Conclusions : Although the overall survival rate was comparable between the SFSS grade A and non-SFSS patients, the up-trend group showed worse short- and long-term outcomes. We should consider aggressive interventions such as portal inflow modulation for up-trend patients with risk factors.
Methods : We collected data from 406 patients diagnosed with SFSS grade A after LDLT between 2018 and 2022 from 12 hospitals in the International Living Donor Liver Transplantation Group. Survival data were also collected from 858 non-SFSS patients. After exclusion, 363 patients comprised 55 (15.2%) in the up-trend group, 251 (69.1%) in the down-trend group, and 57 (15.7%) in the ascites group according to the level and trend of total bilirubin on postoperative day 7 and 14.
Results : There was no difference in survival between SFSS grade A and non-SFSS patients (P=0.152). The up-trend group showed higher 30-day and 90-day mortality than the down-trend and ascites groups (P=0.076 and P=0.030, respectively). The 1-year survival rate significantly differed between the groups (88.8% vs. 93.1% vs. 98.2%, P=0.005). Independent risk factors for survival were up-trend of total bilirubin, recipient age (≥65), MELD score (≥30), and ABO incompatibility. Patients with two or more risk factors had worse survival rates compared to others (P<0.001).
Conclusions : Although the overall survival rate was comparable between the SFSS grade A and non-SFSS patients, the up-trend group showed worse short- and long-term outcomes. We should consider aggressive interventions such as portal inflow modulation for up-trend patients with risk factors.
SESSION
Liver Best Oral Presentation
Room B 3/22/2024 1:30 PM - 2:50 PM