Extreme large‐for‐size syndrome after adult liver transplantation: A model for predicting a potentially lethal complication

Extreme large‐for‐size syndrome after adult liver transplantation: A model for predicting a... TO THE EDITOR:We read with great interest the study by Allard et al. Their conclusions are supported scientifically and echo intuition. It is apparent that the morphology of the right upper abdominal cavity differs among individuals within and across sexes. Combining both of these elegantly to develop a measurable score with which to objectively “match” a donor graft to the intended recipient is well appreciated.At our center, a 58‐year‐old male (A positive; height, 165 cm; weight, 59.8 kg; body mass index, 22 kg/m2) received a liver graft from a group‐matched deceased female donor. On examining the graft in the operating room, it was felt that the size match would be adequate. However, when the graft was sited in the orthotopic position, it was a “snug fit.” The explant and reperfusion were uneventful. The biliary and arterial anastomoses were completed, and Doppler ultrasound examination was normal. The operation lasted 710 minutes with a blood loss of 850 mL. The abdomen was closed primarily with no increase in airway pressures. Within a few hours, the recipient developed severe allograft dysfunction. A further Doppler ultrasound established significant outflow compromise from the graft, although forward adequate flow was maintained in the portal vein. The arterial spectral waveforms http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Liver Transplantation Wiley

Extreme large‐for‐size syndrome after adult liver transplantation: A model for predicting a potentially lethal complication

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Publisher
Wiley Subscription Services, Inc., A Wiley Company
Copyright
© 2018 by the American Association for the Study of Liver Diseases.
ISSN
1527-6465
eISSN
1527-6473
D.O.I.
10.1002/lt.24998
Publisher site
See Article on Publisher Site

Abstract

TO THE EDITOR:We read with great interest the study by Allard et al. Their conclusions are supported scientifically and echo intuition. It is apparent that the morphology of the right upper abdominal cavity differs among individuals within and across sexes. Combining both of these elegantly to develop a measurable score with which to objectively “match” a donor graft to the intended recipient is well appreciated.At our center, a 58‐year‐old male (A positive; height, 165 cm; weight, 59.8 kg; body mass index, 22 kg/m2) received a liver graft from a group‐matched deceased female donor. On examining the graft in the operating room, it was felt that the size match would be adequate. However, when the graft was sited in the orthotopic position, it was a “snug fit.” The explant and reperfusion were uneventful. The biliary and arterial anastomoses were completed, and Doppler ultrasound examination was normal. The operation lasted 710 minutes with a blood loss of 850 mL. The abdomen was closed primarily with no increase in airway pressures. Within a few hours, the recipient developed severe allograft dysfunction. A further Doppler ultrasound established significant outflow compromise from the graft, although forward adequate flow was maintained in the portal vein. The arterial spectral waveforms

Journal

Liver TransplantationWiley

Published: Jan 1, 2018

References

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