Graft Receptor Weight Ratio Impact On Liver Transplantation

Objective:With the development of the medical industry,there are more and more liver transplantations,more and more exquisite transplantation techniques,and lower postoperative mortality.However,because the distribution of donor livers is mainly determined by the severity of the recipient’s condition.The mismatching of liver and receptor size remains a common phenomenon in cadaver liver transplantation.Graft receptor weight ratio(GWRW)is the most commonly used index to evaluate the degree of graft receptor size matching in cadaver liver transplantation.The purpose of this study was to explore the short-term influence of larger graft receptor weight ratio(GWRW)after liver transplantation.Methods:We retrospectively analyzed 174 cases of cadaveric liver transplantation from January 2015 to December 2016.According to foreign literature,they were divided into two groups:graft weight ratio>2.5%and<2.5%.We collected donor and recipient gender,age,and other relevant data of the two groups,and observe liver function,complications,and mortality after transplantation.At last,The statistical analysis was performed on the different parameters of the two receptors groups.We also analyses the risk factors for 1-month mortality after transplantation.Results:In 174 cases,there were 44 patients with graft recipient weight ratios(GWRW)≥2.5%and 130 patients with graft recipient weight ratios(GWRW)<2.5%.30-day mortality rate of the large liver group was significantly higher than another group(15.9%vs 3.8%,p=0.006).Multiple organ failure and sepsis were the two main causes of death,the multiple organ failure happening of GWRW>2.5%group was significantly higher than that of another group(9.1%vs 0.8%,p=0.004).The total bilirubin levels(d7,d14)and alanine aminotransferase levels(dl,d3)were higher in GWRW≥2.5%group than in another group(TB d7:58(25-120)vs 39(17.5-66)μmol/L,p=0.02;TB d14:34(18-64)vs 22(15-40.5)μmol/L,p=0.04;ALT dl:1039.5(525-2100.5)vs 669(390.25-1413.25)U/L,p=0.01;ALT d3:402(207-1031)vs 298(186-538)U/L,p=0.047).In GWRW>2.5%group,a large amount of postoperative pleural fluid(18.2%vs 7.7%,p=0.048),hepatic ischemic necrosis(29.5%vs 13.1%,p=0.047),bile leakage(4.5%vs 0,p=0.01)and the incidence of graft death(3.8%vs 2.3%,p=0.01)was higher than another group,and it had statistically significant.The incidence of other complications had no significance difference between the two groups.We also found that postoperative preoperative bilirubin and GWRW ≥ 2.5%were independent risk factors for mortality within 30 days after surgery.Conclusion:The recipients of graft receptor weight ratio(GWRW)≥ 2.5%group had significantly higher probability in large amounts of pleural effusion,hepatic ischemic necrosis,incidence of bile leakage,and postoperative 30-day mortality.The GWRW>2.5%of the donor liver can not only meet the metabolic needs of the recipient,but may increase the ischemic necrosis of the donor liver,causing adverse effects on the recipient and even life-threatening.Therefore,in the distribution of donor liver,the severity of the receptor disease should be considered in conjunction with graft receptor weight ratio(GWRW)≥ 2.5%indicator.To the extent,the donor liver should be allocated as much as possible to receptors with graft receptor weight ratio(GWRW)<2.5%.