{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T23:38:54Z","timestamp":1793489934330,"version":"4.5.0"},"reference-count":50,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","license":[{"start":{"date-parts":[[2019,10,1]],"date-time":"2019-10-01T00:00:00Z","timestamp":1569888000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,10,1]],"date-time":"2019-10-01T00:00:00Z","timestamp":1569888000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver Transpl"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:p>Although the well\u2010accepted lower limit of the graft\u2010to\u2010recipient weight ratio (GRWR) for successful living donor liver transplantation (LDLT) remains 0.80%, many believe grafts with lower GRWR may suffice with portal inflow modulation (PIM), resulting in equally good recipient outcomes. This study was done to evaluate the outcomes of LDLT with small\u2010for\u2010size grafts (GRWR &lt;0.80%). Of 1321 consecutive adult LDLTs from January 2012 to December 2017, 287 (21.7%) had GRWR &lt;0.80%. PIM was performed (hemiportocaval shunt [HPCS], n\u00a0=\u00a0109; splenic artery ligation [SAL], n\u00a0=\u00a014) in 42.9% patients. No PIM was done if portal pressure (PP) in the dissection phase was &lt;16\u00a0mm Hg. Mean age of the cohort was 49.3\u00a0\u00b1\u00a09.1\u00a0years. Median Model for End\u2010Stage Liver Disease score was 14, and the lowest GRWR was 0.54%. A total of 72 recipients had a GRWR &lt;0.70%, of whom 58 underwent HPCS (1 of whom underwent HPCS\u00a0+\u00a0SAL) and 14 underwent no PIM, whereas 215 had GRWR between 0.70% and 0.79%, of whom 51 and 14 underwent HPCS and SAL, respectively. During the same period, 1034 had GRWR \u22650.80% and did not undergo PIM. Small\u2010for\u2010size syndrome developed in 2.8% patients. Three patients needed shunt closure at 1 and 4 weeks and 60\u00a0months. The 1\u2010year patient survival rates were comparable. In conclusion, with PIM protocol that optimizes postperfusion PP, low\u2010GRWR grafts can be used for appropriately selected LDLT recipients with acceptable outcomes.<\/jats:p>","DOI":"10.1002\/lt.25629","type":"journal-article","created":{"date-parts":[[2019,8,22]],"date-time":"2019-08-22T14:19:37Z","timestamp":1566483577000},"page":"1811-1821","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Is Portal Inflow Modulation Always Necessary for Successful Utilization of Small Volume Living Donor Liver Grafts?"],"prefix":"10.1097","volume":"25","author":[{"given":"Arvinder Singh","family":"Soin","sequence":"first","affiliation":[{"name":"Medanta Institute of Liver Transplantation and Regenerative Medicine,Medanta\u2014The Medicity,Gurugram,Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8998-9633","authenticated-orcid":false,"given":"Sanjay Kumar","family":"Yadav","sequence":"additional","affiliation":[{"name":"Medanta Institute of Liver Transplantation and Regenerative Medicine,Medanta\u2014The Medicity,Gurugram,Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujeet Kumar","family":"Saha","sequence":"additional","affiliation":[{"name":"Medanta Institute of Liver Transplantation and Regenerative Medicine,Medanta\u2014The Medicity,Gurugram,Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Rastogi","sequence":"additional","affiliation":[{"name":"Medanta Institute of Liver Transplantation and Regenerative Medicine,Medanta\u2014The Medicity,Gurugram,Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prashant","family":"Bhangui","sequence":"additional","affiliation":[{"name":"Medanta Institute of Liver Transplantation and Regenerative Medicine,Medanta\u2014The Medicity,Gurugram,Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thiagarajan","family":"Srinivasan","sequence":"additional","affiliation":[{"name":"Medanta Institute of Liver Transplantation and Regenerative Medicine,Medanta\u2014The Medicity,Gurugram,Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neeraj","family":"Saraf","sequence":"additional","affiliation":[{"name":"Medanta Institute of Liver Transplantation and Regenerative Medicine,Medanta\u2014The Medicity,Gurugram,Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4387-0036","authenticated-orcid":false,"given":"Narendra S.","family":"Choudhary","sequence":"additional","affiliation":[{"name":"Medanta Institute of Liver Transplantation and Regenerative Medicine,Medanta\u2014The Medicity,Gurugram,Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjeev","family":"Saigal","sequence":"additional","affiliation":[{"name":"Medanta Institute of Liver Transplantation and Regenerative Medicine,Medanta\u2014The Medicity,Gurugram,Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay","family":"Vohra","sequence":"additional","affiliation":[{"name":"Medanta Institute of Liver Transplantation and Regenerative Medicine,Medanta\u2014The Medicity,Gurugram,Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,10,1]]},"reference":[{"key":"lt25629-bib-0001-20240115","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 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