Large-for-Size Graft in Cadaveric Liver Transplantation: Application of BSA (Body Surface Area) for Prompt Evaluation.

Introduction: In recent years, with the increase in the number of brain-dead donors in Japan, brain-dead liver transplantation has been on the rise. In partial living donor liver transplantation, which accounts for the majority of liver transplants in Japan, small-for-size graft has been a problem in adult recipients, whereas large-for-size graft has not been a matter of debate. We experienced a case in which a large-for-size graft resulted in difficulty when closing the wound. With the increase in brain death transplantation, the exclusion of large-for-size grafts becomes an issue when selecting grafts.

Methods: Retrospective chart review. At Nagoya University, 80 brain-dead liver transplants were performed between Feb. 2005 and Dec. 2023. Comparative evaluation of BSA (body surface area) and was performed on 72 patients, excluding 8 split liver transplants, based on the height and weight of the donor and recipient at the time of transplantation. The state of wound closure was also ascertained from the surgical records.

Results: Seven cases out of 72 were considered "large-for-size" regarding BSA. Among them, 1 "large-for-size" patient had difficulty in closing the abdomen during the surgical procedure.

Conclusions: Prompt screening for matching graft size and donor body size may be possible with BSA. The algorithm allows for rapid and efficient donor-recipient matching while reducing the reliance on advanced imaging in most cases.