Copyright ©The Author(s) 2018.
World J Gastroenterol. Jun 21, 2018; 24(23): 2441-2456
Published online Jun 21, 2018. doi: 10.3748/wjg.v24.i23.2441
Table 1 Recommended minimum graft-to-recipient weight ratio in different studies
Ref.Recommended minimum GRWRn (small vs large)One-year survival (small vs large)Five-year survival (small vs large)Study type
Kiuchi et al[10] (1999)1%276 (49 vs 215)61.2% vs 92.6%NSRS
Lee et al[11] (2003)0.8%141 (10 vs 131)Univariate and multiple analysisNSRS
Moon et al[13] (2010)Less than 0.8%427 (35 vs 392)87.8% vs 90.7%74.1% vs 79.4%RS
Lan et al[14] (2009)Less than 0.8%89 (15 vs 74)73.3% vs 71.6%NSRS
Selzner et al[15] (2009)Less than 0.8%271 (22 vs 249)91.0% vs 89.0%83.0% vs 87%RS
Chen et al[16] (2014)Less than 0.8%196 (45 vs 151)82.2% vs 81.4%71.1% vs 75.5%RS
She et al[17] (2017)Left lobe graft vs right lobe graft218 (19 vs 199)89.5% vs 95.9%89.5% vs 86.8%RS
Lee et al[18] (2014)Less than 0.7%317 (23 vs 294)100% vs 93.2%NSRS
Alim et al[19] (2016)0.6%649Seven patients had GRWR of 0.6%. If MELD score was below 20, donor age below 45, and no signs for any hepatosteatosis, GRWR of 0.6% was safeRS
Lee et al[20] (2015)0.40%NSLowest GRWR of 0.40% had been successfully usedRS
Table 2 Incidence of small-for-size syndrome when using small-for-size grafts n (%)
Ref.nSFSS (Incidence)Factors to SFSSStudy type
Goldaracena et al[21] (2017)NSNSA graft GRWR < 0.8% of predisposes the graft to SFSSRE
Graham et al[22] (2014)NSNSGRWR of 0.8 to 1.0 was established as a lower limit to prevent SFSSRE
Botha et al[23] (2010)211 (4.7)Hemi-portocaval shunt can decrease SFSS incidenceRS
Goralczyk et al[24] (2011)225 (22.7)Posterior cavoplasty can decrease SFSS incidenceRS
Soejima et al[25] (2003)368 (22.2)Cirrhosis predisposes the graft to SFSSRS
Ben-Haim et al[26] (2001)405 (8)Child’s class B or C with received grafts of GRWR < 0.85% predisposes the graft to SFSSRS
Sudhindran et al[27] (2012)NS10%-20%Left lobe grafts predisposes the graft to SFSSRE
Yi et al[28] (2008)298 (27.5)Left lobe grafts predisposes the graft to SFSSRS
Soejima et al[29] (2012)31243 (15.3)Left lobe grafts predisposes the graft to SFSSRS
Gruttadauria et al[30] (2015)8313 (15.7)Non-surgical modulation of the portal inflow can decrease SFSS incidenceRS
Shoreem et al[31] (2017)17420 (11.5)Left lobe grafts predisposes the graft to SFSSRS
Lauro et al[32] (2007)84 (50)Surgical modulation of the portal inflow can decrease SFSS incidenceRS
Table 3 Remedies when using small-for-size graft
Ref.nRemedy for using small-for-size graftStudy type
Botha et al[23] (2010)21Hemi-portocaval shunt can decrease SFSS incidenceRS
Goralczyk et al[24] (2011)22Posterior cavoplasty can decrease SFSS incidenceRS
Kim et al[47] (2017)160Preserving collateral veins on small-for-size graftsRS + PSM
Hessheimer et al[48] (2011)NSPortocaval shuntAE
Xiao et al[49] (2012)1Transjugular intrahepatic portosystemic shuntCR
Sato et al[50] (2008)4Portocaval shunt using ligamentum teresCR
Nutu et al[51] (2018)2Complete splenic embolizationCR
Badawy et al[52] (2017)164SplenectomyRS
Troisi et al[53] (2016)NSSplenic artery ligation, splenectomy, meso-caval shunt, spleno-renal shunt, portocaval shunt, and splenic artery embolizationSR
Xu et al[54] (2015)NSDual graftsRE
Gao et al[55] (2017)NSAdipose-derived mesenchymal stem cells tranplantationAE
Kobayashi et al[56] (2009)5Auxiliary partial liver transplantationCR
Table 4 Older donors for living donor liver transplantation
Ref.Definition of older donorsn (older vs young)One-year survival (older vs young)Five-year survival (older vs young)Study type
Tanemura et al[58] (2012)50 yr old101 (24 vs 77)Older donor livers might have impaired regenerative abilityRS
Ono et al[60] (2011)50 yr old15 (6 vs 9)Liver regeneration is impaired with age after donor hepatectomyRS
Akamatsu et al[61] (2007)50 yr old299 (62 vs 237)85.0% vs 93.0%72.0% vs 87.0%RS
Kawano et al[62] (2014)NS12Donor age is a crucial factor affecting telomere length sustainability in hepatocytes after pediatric LDLTPS
Imamura et al[63] (2017)NS198A worse outcome might be associated with aging of the donorRS
Dayangac et al[64] (2011)50 yr old150 (28 vs 122)78.6% vs 83.4%NSRS
Yoshizumi et al[65] (2008)NS28Graft size, donor age, and patient status are the indicators of early graft functionRS
Han et al[66] (2014)55 yr old604 (26 vs 578)Median OS (M): 31.2 ± 31.3 vs 50.6 ± 40.6RS
Kamo et al[67] (2015)60 yr old1597 (69 vs 1528)69.5% vs 81.2%62.0% vs 79.3%RS
Shin et al[68] (2013)Donor-recipient age gradient > 20821Worse graft survival was observed if the donor is older than the recipient by > 20RS
Kubota et al[69] (2017)50 yr old315 (126vs 189)73.0% vs 80.9%39.7% vs 47.1%RS
Katsuragawa et al[70]NS24G/SLV and donor age were independent factors that affected graft survival ratesRS
Wang et al[72] (2015)50 yr old159 (10 vs 149)100% vs 93.0%90.0% vs 87.0%RS
Ikegami et al[73] (2008)50 yr old232 (32 vs 200)80.0% vs 81.7%73.8% vs 76.7%RS
Li et al[74] (2012)50 yr old129 (21 vs 108)90.0% vs 86.0%66.0% vs 75%RS
Goldaracena et al[75] (2016)50 yr old469 (91 vs 378)92.0% vs 96.0%83.0% vs 79.0%RS
Kim et al[76] (2017)55 yr old540 (42 vs 498)95.2% vs 94.6%NSRS
Table 5 Impact of ABO-incompatible on living donor liver transplantation
Ref.nComplicationsIncidence of related complication (%)Risk factorsStudy type
Miyata et al[80] (2007)57Thrombotic microangiopathy7.0ABO-incompatibility, CPA, and recipient blood group (type O)RS
Oya et al[81] (2008)1Thrombotic microangiopathyNSABO-incompatible LDLT (type B to O)CR
Kishida et al[82] (2016)129Thrombotic microangiopathy10.1ABO-incompatible, tacrolimusRS
Song et al[83] (2014)1102Biliary stricture15.8ABO-incompatible, acute cellular rejectionRS
Ikegami et al[84] (2016)408Biliary stricture20.4ABO-incompatibleRS
Yamada et al[88] (2010)1Idiopathic hypereosinophilicNSABO-incompatibleCR
Table 6 Remedies when using ABO- incompatible on living donor liver transplantation
Ref.nImmunosuppression strategyRemediesConclusionStudy type
Kawagishi et al[89] (2009)105TAC + MP + AZRituximabABO-incompatible LDLT can be feasible used if humoral rejection are overcomeRS
Yoon et al[90] (2018)918TAC + MP + steroidsRituximab and PEABO-incompatible LDLT is a feasible option under remediesRS
Sakai et al[91] (2017)20TAC+ MPRituximab and PEFCGR SNPs influence the effect of rituximab on B-cellsPS
Egawa et al[92] (2017)33TACRituximab, PE, local infusion, splenectomy and immunoglobulinsOnly rituximab dose is a significantly favorable factor for AMRRS
Ikegami et al[93] (2007)1TAC + MP + steroidsRituximab and PERituximab and plasma exchanges seemed ineffectiveCR
Ikegami et al[94] (2009)7TAC + MP + steroidsRituximab, IVIG, and PERituximab, IVIG, and PE seems to be a safe treatmentRS
Usui et al[95] (2007)73TAC + MP + steroidsRituximab, PE and splenectomyBone suppression is a big challenge when using rituximabRS
Chen et al[96] (2017)2TAC + MP + steroidsBasiliximab combine with splenectomyABO-i LDLT with splenectomy is undoubtedly life-savingCR
Uchiyama et al[97] (2011)15TAC + MP + steroidsRituximab and PEIsoagglutinin mediated-rejection should be more concernedRS
Soin et al[98] (2014)3TAC + MP + steroidsRituximab and PEABO-incompatible LDLT is a feasible option under remediesCR
Rummler et al[99] (2017)10TAC + MP + steroidsPEImmunosuppression only combining with PE is feasibleRS
Kim et al[100] (2016)182TAC + MP + steroidsRituximab, IVIG, and PEABO-incompatible LDLT can be safely performed under remediesRS
Kim et al[101] (2013)22TAC + MP + steroidsRituximab and PEABO-incompatible LDLT can be safely performed under remediesRS
Kawagishi et al[102] (2005)3TAC + MP + steroidsRituximab and PEABO-incompatible LDLT can be safely performed under remediesCR
Kim et al[103] (2017)43TAC + MP + steroidsRituximab and IVIGA simplified protocol using rituximab and IVIG for ABO-I LDLT is safeRS
Yoshizawa et al[104] (2005)8TAC + MP + cyclophosphamideRituximab and PGE1 infusionRituximab prophylaxis and HA infusion therapy is feasibleRS
Egawa et al[105] (2008)118TAC + steroidsMethylprednisolone and PGE1 infusionRecipients with preexisting high effector CD8 T- cells are unfavorable candidates for ABO-I LDLTRS
Yamamoto et al[106] (2018)40TAC + MP + steroidsRituximab monotherapyRituximab monotherapy is feasibleRS
Table 7 Impact of graft steatosis on living donor liver transplantation
Ref.nConclusionStudy type
Dirican et al[9] (2015)161Approximately 40% of donor grafts are discarded because of severe liver steatosisRS
Perkins et al[109] (2006)NSTypically steatotic livers with > 60% fat are not transplanted; with < 30% fat are usable and anticipated to have good function; with 30%-60% fat give poor resultsComments
Kotecha et al[110] (2013)340Hepatic steatosis is a leading cause of donor rejection in LDLTPS
Cho et a[111]l (2010)54Hepatocyte replication is impaired during steatotic liver regeneration after LDLTPS
Cho et al[112] (2006)67Hepatic steatosis is associated with intrahepatic cholestasis and transient hyperbilirubinemia during regenerationPS
Cho et al[113] (2005)55Mildly steatotic graft did not increase the risk of graft dysfunction or morbidity in LDLTPS
Gao et al[114] (2009)24Moderately steatotic (30%-60%) liver grafts provide adequate function in the first phase after transplantation and can be used for transplantationRS
Knaak et al[115] (2017)105Donors with BMI > 30, in the absence of graft steatosis, are not contraindicated for LDLTRS
Han et al[116] (2015)211The risk of steatosis may be determined by the relative composition of MiS and MaS, rather than the total quantitative degreeRS
Table 8 Treatments for fat donors
Ref.nTreatmentsStudy type
Oshita et al[117] (2012)128Diet treatment consisting of an 800 to 1400 kcal/d diet and a 100 to 400 kcal/d exercise regimen without drug treatment, targeting body mass index of 22 kg/m²RS
Nakamuta et al[118] (2013)11Bezafibrate (400 mg/d) was used along with a protein-rich (1000 kcal/d) diet and exercise (600 kcal/d) for 2-8 wkRS
Choudhary et al[119] (2015)161200 kcal/d and a minimum of 60 min/d of moderate cardio training are also recommended to rapidly reverse liver steatosis in donorsPS
Moon et al[120] (2006)2Dual-graft living donor liver transplantation for severe graft steatosisCR
Table 9 Impact of HBsAg or HBcAb(+) grafts on HBsAg(-) living donor liver transplantation patients
Ref.DonorIncidence of de novo HBV infection (%)Prevention of de novo HBV infectionStudy type
Wang[121] (2017)HBcAb(+)4.2HBV vaccinations with the aim of achieving anti-HBs > 1000 IU/L pre-transplant and > 100 IU/L post-transplantRS
Xi et al[122] (2013)HBcAb(+)23.9No prophylaxis, adefovir, and lamivudine are given to de novo patientsRS
Dong et al[123] (2017)HBcAb(+)7.9HBIG 100 IU/kg during the operation and lamivudine 3 mg/kg per day after the surgery for at least 1 year until HBV vaccine reactionRS
Loggi et al[124] (2016)HBsAg(+)NSHBIG and lamivudine, adefovir or tenofovirSR
Lei et al[125] (2013)HBcAb(+)15.0No specific prophylaxisRS
Lin et al[126] (2007)HBcAb(+)3.3Lamivudine monoprophylaxis, HBV vaccinationsRS
Hara et al[127] (2016)HBcAb(+)NSLamivudine first and adefovir dipivoxil were combined with lamivudine 2 yr laterCR
Table 10 Impact of HBsAg or HBcAb(+) grafts on HBsAg(+) living donor liver transplantation patients
Ref.DonorIncidence of de novo HBV infectionPrevention of De Novo HBV infectionStudy type
Hwang et al[129] (2006)HBsAg(+)NSHigh-dose HBIG and lamivudine, famciclovir and interferon; a final regimen of lamivudine and adefovirCR
Soejima et al[130] (2007)HBsAg(+)NSlamivudine and adefovir dipivoxilCR
Jeng et al[131] (2015)HBsAg(+)NSEntecavir 0.5 mg once dailyRS
Table 11 Graft with hepatic benign tumor
Ref.nType of tumors in graftsPrognosisStudy type
Li et al[133] (2017)15Cavernous hemangioma, perivascular epithelioid cell tumor, inflammatory pseudotumor, and focal nodular hyperplasiaOne patient died from pulmonary embolismOS
Fuchino et al[134] (2017)1HBsAg(+) and inflammatory pseudotumorTumor vanished after 3 yrCR