Introduction: Graf size is not an essential factor in small-for-size syndrome. However, small-for-size grafts (SFSG) are still an important cause of early allograft dysfunction (EAD) in living donor liver transplantation (LDLT). This study compared the safety of modified right lobe (MRL) graft and extended left lobe (ELL) graft in SFSG.​
Method: From June 2009 to August 2023, in LDLT, there were 42 patients with a graft recipient weight ratio (GRWR) of 0.8 or less at our center. Among them, 31 patients underwent LDLT with the MRL graft, and 11 patients underwent LDLT with the ELL graft. In these two groups, the recipient outcomes were compared according to the type of graft. The medical records of LDLT with SFSG at Seoul St. Mary’s Hospital were retrospectively reviewed.
Results: 83.9% of males in the MRL group were higher than 36.4% of the ELL group (p = 0.01). There were no differences between the two groups in GRWR, Child score, or MELD score. In the postoperative outcome, there was no difference in bile leak between the two groups, but biliary stricture occurred more frequently in 14 patients (45.2%) in the MRL group than in 1 patient (9.1%) in the ELL group (p=0.03). Hospital stay after LDLT was 49.7 days in the MRL group and 25.4 days in the ELL group, which was longer in the MRL group (p = 0.04). Hospital mortality occurred in 2 patients only in the MRL group and none in the ELL group. The 5-year survival rate was 61.9% in the MRL group and 100% in the ELL group, which was higher in the ELL group (p = 0.05).
Conclusions: In SFSG, ELL graft shows a better prognosis than MRL graft. Therefore, if the ELL graft is considered, LDLT can be performed more positively, even if it is SFSG.