{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T22:24:56Z","timestamp":1787869496390,"version":"build-2784847793"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","license":[{"start":{"date-parts":[[2009,12,1]],"date-time":"2009-12-01T00:00:00Z","timestamp":1259625600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2009,11,24]],"date-time":"2009-11-24T00:00:00Z","timestamp":1259020800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2009,12]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Many centers require a minimal graft to body weight ratio (GBWR) \u2265 0.8 as an arbitrary threshold to proceed with right-lobe living donor liver transplantation (RL-LDLT), and there is often hesitancy about transplanting lower volume living donor (LD) liver grafts into sicker patients. The data supporting this dogma, based on the early experience with RL-LDLT at Asian centers, are weak. To determine the effect of LD liver volume in the modern era, we investigated the impact of GBWR on the outcome of RL-LDLT with a GBWR as low as 0.6 at the University of Toronto. Between April 2000 and September 2008, 271 adult-to-adult RL-LDLT procedures and 614 deceased donor liver transplants were performed. Twenty-two living donor liver transplantation (LDLT) cases with a GBWR of 0.59 to 0.79 (group A) were compared with 249 LDLT cases with a GBWR \u2265 0.8 (group B) and with 66 full-graft deceased donor liver transplants (group C), who were matched 3:1 according to donor and recipient age, Model for End-Stage Liver Disease score, and presence of hepatitis C and hepatocellular carcinoma with the low-GBWR group. Portal vein shunts were not used. Markers of reperfusion injury [aspartate aminotransferase (AST) and alanine aminotransferase (ALT)], graft function (international normalized ratio and bilirubin), complications graded by the Clavien score, and graft and patient survival were compared. As expected, LD recipients had a significantly shorter cold ischemia time (94 \u00b1 43 minutes for A, 96 \u00b1 57 minutes for B, and 453 \u00b1 152 minutes for C,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.0001). However, the peak AST, peak ALT, absolute decrease in the international normalized ratio, day 7 bilirubin level, postoperative creatinine clearance, complication rate graded by the Clavien score, and median hospital stay were similar in all groups. The rate of biliary complications was higher with LD grafts than deceased donor grafts (19% for A versus 10% for B and 0% for C,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.2). Patient survival was similar in all groups at 1, 3, and 5 years (91% for A versus 89% for B and 93% for C at 1 year, 87% for A versus 81% for B and 89% for C at 3 years, and 83% for A versus 81% for B and 87% for C at 5 years,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.63). A Cox proportional regression analysis revealed only hepatitis C virus as a risk factor for poorer graft survival and not GBWR as a continuous or categorical variable. In conclusion, we found no evidence of inferior outcomes with smaller size grafts versus larger size LD grafts or full-size deceased donor grafts. Further studies are warranted to examine the factors affecting the function of smaller grafts for living liver donation and thereby define the safe lower limits for transplantation. Liver Transpl 15:1776-1782, 2009. \u00a9 2009 AASLD.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lt.21955","type":"journal-article","created":{"date-parts":[[2009,11,24]],"date-time":"2009-11-24T14:48:00Z","timestamp":1259074080000},"page":"1776-1782","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":99,"title":["A Graft to Body Weight Ratio Less Than 0.8 Does Not Exclude Adult-to-Adult Right-Lobe Living Donor Liver Transplantation"],"prefix":"10.1097","volume":"15","author":[{"given":"Markus","family":"Selzner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arash","family":"Kashfi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark S.","family":"Cattral","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazia","family":"Selzner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul D.","family":"Greig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Les","family":"Lilly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian D.","family":"McGilvray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Therapondos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesley E.","family":"Adcock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand","family":"Ghanekar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary A.","family":"Levy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eberhard L.","family":"Renner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Grant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-15-20260302","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/lt.500060117","article-title":"Right lobe living donor liver transplantation: a review.","volume":"6","author":"Marcos","year":"2000","journal-title":"Liver Transpl"},{"key":"R2-15-20260302","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1067\/j.cpsurg.2004.12.003","article-title":"The current status of living donor liver transplantation.","volume":"42","author":"Tuttle-Newhall","year":"2005","journal-title":"Curr Probl Surg"},{"key":"R3-15-20260302","doi-asserted-by":"crossref","first-page":"1802","DOI":"10.1053\/j.gastro.2008.02.092","article-title":"Live donors in liver transplantation.","volume":"134","author":"Brown","year":"2008","journal-title":"Gastroenterology"},{"key":"R4-15-20260302","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1097\/00007890-199901270-00024","article-title":"Impact of graft size mismatching on graft prognosis in liver transplantation from living donors.","volume":"67","author":"Kiuchi","year":"1999","journal-title":"Transplantation"},{"key":"R6-15-20260302","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1111\/j.1432-2277.2004.tb00448.x","article-title":"Is graft size a major risk factor in living-donor adult liver transplantation?","volume":"17","author":"Shimada","year":"2004","journal-title":"Transpl Int"},{"key":"R7-15-20260302","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1002\/lt.20743","article-title":"Quantitative survival model for short-term survival after adult-to-adult living donor liver transplantation.","volume":"12","author":"Tsunematsu","year":"2006","journal-title":"Liver Transpl"},{"key":"R8-15-20260302","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1097\/00000658-200104000-00014","article-title":"Small graft for living donor liver transplantation.","volume":"233","author":"Nishizaki","year":"2001","journal-title":"Ann Surg"},{"key":"R9-15-20260302","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1111\/j.1600-6143.2004.00405.x","article-title":"Living-donor right hepatectomy with or without inclusion of middle hepatic vein: comparison of morbidity and outcome in 56 patients.","volume":"4","author":"Cattral","year":"2004","journal-title":"Am J Transplant"},{"key":"R10-15-20260302","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1155\/2006\/320530","article-title":"Adult-to-adult living donor liver transplantation.","volume":"20","author":"Shah","year":"2006","journal-title":"Can J Gastroenterol"},{"key":"R11-15-20260302","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann Surg"},{"key":"R12-15-20260302","doi-asserted-by":"crossref","first-page":"3663","DOI":"10.1016\/j.transproceed.2006.10.054","article-title":"Renal disease burden following liver transplantation.","volume":"38","author":"Kim","year":"2006","journal-title":"Transplant Proc"},{"key":"R13-15-20260302","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1053\/jlts.2002.31654","article-title":"Body surface area and body weight predict total liver volume in Western adults.","volume":"8","author":"Vauthey","year":"2002","journal-title":"Liver Transpl"},{"key":"R14-15-20260302","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1016\/S1072-7515(01)00800-6","article-title":"Small-for-size grafts in living-related liver transplantation.","volume":"192","author":"Sugawara","year":"2001","journal-title":"J Am Coll Surg"},{"key":"R15-15-20260302","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1016\/S0041-1345(00)01583-9","article-title":"Standard liver volume in adults.","volume":"32","author":"Urata","year":"2000","journal-title":"Transplant Proc"},{"key":"R16-15-20260302","doi-asserted-by":"crossref","first-page":"1710","DOI":"10.1111\/j.1440-1746.2006.04433.x","article-title":"Estimation of standard liver volume in Japanese living liver donors.","volume":"21","author":"Hashimoto","year":"2006","journal-title":"J Gastroenterol Hepatol"},{"key":"R17-15-20260302","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1097\/00007890-199910270-00009","article-title":"Minimum graft size for successful living donor liver transplantation.","volume":"68","author":"Lo","year":"1999","journal-title":"Transplantation"},{"key":"R18-15-20260302","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1016\/S0041-1345(00)02527-6","article-title":"Outcome of adult living donor liver transplantation using small volume of left liver graft less than 1 of body weight.","volume":"33","author":"Suh","year":"2001","journal-title":"Transplant Proc"},{"key":"R19-15-20260302","doi-asserted-by":"crossref","first-page":"2605","DOI":"10.1111\/j.1600-6143.2005.01081.x","article-title":"Small-for-size syndrome after partial liver transplantation: definition, mechanisms of disease and clinical implications.","volume":"5","author":"Dahm","year":"2005","journal-title":"Am J Transplant"},{"key":"R20-15-20260302","first-page":"150","article-title":"The small for size liver syndrome.","volume":"11","author":"Tucker","year":"2005","journal-title":"Curr Opin Crit Care"},{"key":"R21-15-20260302","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1053\/jlts.2003.50198","article-title":"Small-for-size graft in living donor liver transplantation: how far should we go?","volume":"9","author":"Kiuchi","year":"2003","journal-title":"Liver Transpl"},{"key":"R22-15-20260302","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1053\/jlts.2003.50193","article-title":"Small-for-size syndrome: what is the problem?","volume":"9","author":"Troisi","year":"2003","journal-title":"Liver Transpl"},{"key":"R23-15-20260302","doi-asserted-by":"crossref","first-page":"S26","DOI":"10.1053\/jlts.2003.50197","article-title":"Small-for-size liver syndrome after auxiliary and split liver transplantation: donor selection.","volume":"9","author":"Heaton","year":"2003","journal-title":"Liver Transpl"},{"key":"R24-15-20260302","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.jss.2007.09.010","article-title":"Small-for-size syndrome in the rat: does size or technique matter?","volume":"149","author":"Dahmen","year":"2008","journal-title":"J Surg Res"},{"key":"R25-15-20260302","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1111\/j.1432-2277.2008.00678.x","article-title":"The beneficial role of simultaneous splenectomy in living donor liver transplantation in patients with small-for-size graft.","volume":"21","author":"Yoshizumi","year":"2008","journal-title":"Transpl Int"},{"key":"R26-15-20260302","doi-asserted-by":"crossref","first-page":"2234","DOI":"10.1016\/j.transproceed.2004.08.027","article-title":"Inferior mesenteric venous left renal vein shunting for decompression of excessive portal hypertension in adult living related liver transplantation.","volume":"36","author":"Sato","year":"2004","journal-title":"Transplant Proc"},{"key":"R27-15-20260302","doi-asserted-by":"crossref","first-page":"2825","DOI":"10.1016\/j.transproceed.2008.08.080","article-title":"Successful super-small-for-size graft liver transplantation by decompression of portal hypertension via splenectomy and construction of a mesocaval shunt: a case report.","volume":"40","author":"Kokai","year":"2008","journal-title":"Transplant Proc"},{"key":"R28-15-20260302","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1111\/j.1600-6143.2005.00850.x","article-title":"Effects of hemi-portocaval shunts for inflow modulation on the outcome of small-for-size grafts in living donor liver transplantation.","volume":"5","author":"Troisi","year":"2005","journal-title":"Am J Transplant"},{"key":"R29-15-20260302","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1002\/lt.20164","article-title":"End-to-side portocaval shunting for a small-for-size graft in living donor liver transplantation.","volume":"10","author":"Takada","year":"2004","journal-title":"Liver Transpl"},{"key":"R30-15-20260302","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1002\/lt.21080","article-title":"Transient portacaval shunt for a small-for-size graft in living donor liver transplantation.","volume":"13","author":"Taniguchi","year":"2007","journal-title":"Liver Transpl"},{"key":"R31-15-20260302","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1111\/j.1600-6143.2007.02045.x","article-title":"Does the permanent portacaval shunt for a small-for-size graft in a living donor liver transplantation do more harm than good?","volume":"8","author":"Oura","year":"2008","journal-title":"Am J Transplant"}],"container-title":["Liver Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Flt.21955","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Flt.21955","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/01445473-200912000-00015","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T16:01:40Z","timestamp":1772467300000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/01445473-200912000-00015"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,12]]},"references-count":30,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2009]]}},"URL":"https:\/\/doi.org\/10.1002\/lt.21955","relation":{},"ISSN":["1527-6465"],"issn-type":[{"value":"1527-6465","type":"print"}],"subject":[],"published":{"date-parts":[[2009,12]]}}}