A new surgical strategy for preventing large-for-size syndrome after DCD liver transplantation in adults_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

JIANG Li ,  YAN Lünan ,  YANG Jiayin

Department of Liver Surgery/Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

YAN Lünan, Email: yanlunan688@163.com; YANG Jiayin, Email: doctoryjy@scu.edu.cn

Keywords：

large-for-size syndrome; reduced-size liver transplantation; split liver transplantation; ex vivo right posterior sectionectomy

DOI：

10.7507/1007-9424.202204025

Video：

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Abstract Full text Figures/Tables Video References Cited by

Large-for-size syndrome (LFSS) is a fatal complication of abdominal and thoracic organ compression due to mismatch of the size of the graft and recipient abdominal cavity. In recent years, with the increased prevalence of obesity epidemic among the donor pool, the incidence of LFSS tends to increase in adult liver transplantation. However, it is still unclear how to effectively prevent LFSS after adult death after citizen death (DCD) liver transplantation. Almost all transplantation centers rely on experience to deal with it, and there is no objective prevention strategy. This article summarizes the current problems in preventing LFSS after adult DCD liver transplantation, and our team’s exploration of the existing problems.

Citation： JIANG Li, YAN Lünan, YANG Jiayin. A new surgical strategy for preventing large-for-size syndrome after DCD liver transplantation in adults. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(5): 576-581. doi: 10.7507/1007-9424.202204025 Copy

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2.	Jacob M, Saif R, Reddy J, et al. Extreme large-for-size syndrome after adult liver transplantation: a model for predicting a potentially lethal complication. Liver Transpl, 2018, 24(3): 442-443.
3.	Addeo P, Noblet V, Naegel B, et al. Large-for-size orthotopic liver transplantation: a systematic review of definitions, outcomes, and solutions. J Gastrointest Surg, 2020, 24(5): 1192-1200.
4.	Tschuor C, Ferrarese A, Kuemmerli C, et al. Allocation of liver grafts worldwide - is there a best system? J Hepatol, 2019, 71(4): 707-718.
5.	Fukazawa K, Nishida S, Volsky A, et al. Body surface area index predicts outcome in orthotopic liver transplantation. J Hepatobiliary Pancreat Sci, 2011, 18(2): 216-225.
6.	Levesque E, Duclos J, Ciacio O, et al. Influence of larger graft weight to recipient weight on the post-liver transplantation course. Clin Transplant, 2013, 27(2): 239-247.
7.	Croome KP, Lee DD, Saucedo-Crespo H, et al. A novel objective method for deceased donor and recipient size matching in liver transplantation. Liver Transpl, 2015, 21(12): 1471-1477.
8.	Allard MA, Lopes F, Frosio F, et al. Extreme large-for-size syndrome after adult liver transplantation: a model for predicting a potentially lethal complication. Liver Transpl, 2017, 23(10): 1294-1304.
9.	Emond JC, Freeman RB Jr, Renz JF, et al. Optimizing the use of donated cadaver livers: analysis and policy development to increase the application of split-liver transplantation. Liver Transpl, 2002, 8(10): 863-872.
10.	Kim YM, Kwak BJ, Shim DJ, et al. In situ left lateral sectionectomy in deceased donor liver transplantation: could this be another solution for a large-for-size graft? A case report. Transplant Proc, 2019, 51(9): 3116-3119.
11.	Nagatsu A, Yoshizumi T, Ikegami T, et al. In situ posterior graft segmentectomy for large-for-size syndrome in deceased donor liver transplantation in adults: a case report. Transplant Proc, 2017, 49(5): 1199-1201.
12.	Kim EY, Yoon YC. Performing a right hemihepatectomy sequentially after deceased donor liver transplantation–the solution for a large-for-size graft: a case report. Transplant Proc, 2015, 47(10): 3023-3026.
13.	Eldeen FZ, Lee CF, Lee CS, et al. “Passing loop” technique: a new modification of the piggyback technique tailored to voluminous liver grafts–case report. Transplant Proc, 2013, 45(2): 831-832.
14.	Zhang ZX, Pu XY, Yang J, et al. Reduced-right posterior sector salvage liver transplantation using a moderate steatotic graft from one obese donor after cardiac death. Chin Med J (Engl), 2020, 134(5): 596-598.
15.	Pu X, He D, Liao A, et al. A novel strategy for preventing posttransplant large-for-size syndrome in adult liver transplant recipients: a pilot study. Transpl Int, 2022, 35: 10177. doi: 10.3389/ti.2021.10177.

1. Ersoy Z, Kaplan S, Ozdemirkan A, et al. Effect of graft weight to recipient body weight ratio on hemodynamic and metabolic parameters in pediatric liver transplant: a retrospective analysis. Exp Clin Transplant, 2017, 15(Suppl 1): 53-56.
2. Jacob M, Saif R, Reddy J, et al. Extreme large-for-size syndrome after adult liver transplantation: a model for predicting a potentially lethal complication. Liver Transpl, 2018, 24(3): 442-443.
3. Addeo P, Noblet V, Naegel B, et al. Large-for-size orthotopic liver transplantation: a systematic review of definitions, outcomes, and solutions. J Gastrointest Surg, 2020, 24(5): 1192-1200.
4. Tschuor C, Ferrarese A, Kuemmerli C, et al. Allocation of liver grafts worldwide - is there a best system? J Hepatol, 2019, 71(4): 707-718.
5. Fukazawa K, Nishida S, Volsky A, et al. Body surface area index predicts outcome in orthotopic liver transplantation. J Hepatobiliary Pancreat Sci, 2011, 18(2): 216-225.
6. Levesque E, Duclos J, Ciacio O, et al. Influence of larger graft weight to recipient weight on the post-liver transplantation course. Clin Transplant, 2013, 27(2): 239-247.
7. Croome KP, Lee DD, Saucedo-Crespo H, et al. A novel objective method for deceased donor and recipient size matching in liver transplantation. Liver Transpl, 2015, 21(12): 1471-1477.
8. Allard MA, Lopes F, Frosio F, et al. Extreme large-for-size syndrome after adult liver transplantation: a model for predicting a potentially lethal complication. Liver Transpl, 2017, 23(10): 1294-1304.
9. Emond JC, Freeman RB Jr, Renz JF, et al. Optimizing the use of donated cadaver livers: analysis and policy development to increase the application of split-liver transplantation. Liver Transpl, 2002, 8(10): 863-872.
10. Kim YM, Kwak BJ, Shim DJ, et al. In situ left lateral sectionectomy in deceased donor liver transplantation: could this be another solution for a large-for-size graft? A case report. Transplant Proc, 2019, 51(9): 3116-3119.
11. Nagatsu A, Yoshizumi T, Ikegami T, et al. In situ posterior graft segmentectomy for large-for-size syndrome in deceased donor liver transplantation in adults: a case report. Transplant Proc, 2017, 49(5): 1199-1201.
12. Kim EY, Yoon YC. Performing a right hemihepatectomy sequentially after deceased donor liver transplantation–the solution for a large-for-size graft: a case report. Transplant Proc, 2015, 47(10): 3023-3026.
13. Eldeen FZ, Lee CF, Lee CS, et al. “Passing loop” technique: a new modification of the piggyback technique tailored to voluminous liver grafts–case report. Transplant Proc, 2013, 45(2): 831-832.
14. Zhang ZX, Pu XY, Yang J, et al. Reduced-right posterior sector salvage liver transplantation using a moderate steatotic graft from one obese donor after cardiac death. Chin Med J (Engl), 2020, 134(5): 596-598.
15. Pu X, He D, Liao A, et al. A novel strategy for preventing posttransplant large-for-size syndrome in adult liver transplant recipients: a pilot study. Transpl Int, 2022, 35: 10177. doi: 10.3389/ti.2021.10177.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

A new surgical strategy for preventing large-for-size syndrome after DCD liver transplantation in adults

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