Graft size, donor age, and patient status are the indicators of early graft function after living donor liver transplantation

✍ Scribed by Tomoharu Yoshizumi; Akinobu Taketomi; Hideaki Uchiyama; Noboru Harada; Hiroto Kayashima; Yo-Ichi Yamashita; Yuji Soejima; Mitsuo Shimada; Yoshihiko Maehara

• Publisher: John Wiley and Sons
• Year: 2008
• Tongue: English
• Weight: 254 KB
• Volume: 14
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.21462

✦ Synopsis

No reliable model for predicting early graft function and patient survival after living donor liver transplantation (LDLT) exists. The aim of this study was to establish a new formula for predicting early graft function and prognosis using technetium-99m galactosyl-human serum albumin (Tc-GSA) liver scintigraphy. The ratio of the hepatic uptake ratio of Tc-GSA to the clearance index of Tc-GSA (LHL/HH) was determined 7 days after LDLT. There were 22 patients with a ratio greater than 1.3 and 6 patients with a ratio less than 1.3. Graft function on the 14th postoperative day (POD) was compared between the 2 groups. A new formula to predict the LHL/HH score was established as follows: LHL/HH (predictive score) ϭ 0.011 ϫ graft weight (%) Ϫ 0.016 ϫ donor age Ϫ 0.008 ϫ Model for End-Stage Liver Disease score Ϫ 0.15 ϫ shunt (if present) ϩ 1.757 (r 2 ϭ 0.497, P Ͻ 0.01). This predicted LHL/HH ratio was compared to the graft function on POD 14 for 110 LDLT patients. The total bilirubin (TB) and prothrombin time international normalized ratio (PT-INR) in the group with an LHL/HH score Ն 1.3 were lower than those in the group with an LHL/HH score Ͻ 1.3. The TB, PT-INR, and volume of ascites in the group with a predictive score Ն 1.3 (n ϭ 86) were lower than those in the group with a score Ͻ 1.3 (n ϭ 24). The 6-month survival probability was improved in the group with a predictive score Ն 1.3. In conclusion, this preoperative calculated LHL/HH score is correlated with graft function and short-term prognosis. Thus, this predictive model may allow transplant surgeons to use a living donor left lobe graft with greater confidence.