A retrospective study investigating the risk of graft loss in living donor liver transplant cases where size mismatching is predicted from graft-to-recipient weight ratio

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Key takeaways

• GRWR outside 0.8-3.5% range can be safely managed with intraoperative adjustments like splenectomy and delayed abdominal closure.
• No significant difference in 5-year patient/graft survival or thrombosis rates when GRWR criteria expanded beyond traditional thresholds.
• 46% of size-mismatched cases required splenectomy or delayed closure to optimize portal flow and accommodate graft size.
• Traditional GRWR criteria may be safely expanded in pediatric LDLT when appropriate surgical modifications are employed.
• Portal flow modulation and abdominal wall management are key strategies for mitigating size mismatch complications in LDLT.

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