Transplant Trial Watch

The role of graft to recipient weight ratio on enhanced recovery of the recipient after living donor liver transplantation - A systematic review of the literature and expert panel recommendations.

Patel, M. S., et al.

Clinical Transplantation 2022; 36(10): e14630.

This study aimed to determine the lower limit of graft-to-recipient weight ratio (GRWR) compatible with enhanced recovery following living donor liver transplant (LDLT) and to provide expert panel recommendations.

Electronic databases including Ovid MEDLINE, Scopus, Embase, Google Scholar and Cochrane Central were searched. Titles and abstracts were screened by two independent reviewers. Quality of studies and recommendations grading was performed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

20 studies were included in the review.

The primary outcomes were graft function, other complications, and length of stay at hospital and intensive care unit (ICU). Secondary outcomes were patient and graft survival.


CET Conclusions
This systematic review was based on a broad search of multiple databases but there is no explicit reference to searching duplicate or duplicate extraction of data. 20 studies were included, with all being retrospective, observational studies. The included studies were heterogenous, with most not reporting outcomes of interest (ICU stay, hospital stay, graft function). The authors concluded that the level of evidence was low, however they make a strong recommendation that Graft-Recipient Weight Ratio >0.8% is strongly associated with enhanced recovery following liver donor liver transplantation. There is no meta-analysis conducted and only 2 of the included studies performed a statistical analysis showing a significant reduction in Small For Size Syndrome comparing GRWR >0.8% to <0.8%. The conclusion is therefore largely based upon expert consensus.

Trial registration
PROSPERO - CRD42021260794

Funding source
Non-industry funded