Section 7. A new therapeutic strategy on portal flow modulation that increases donor safety with good recipient outcomes.

The goal of this study was to examine whether the lower limit of the graft-to-recipient weight ratio (GRWR) can be safely reduced to make better use of the left lobe graft in adult-to-adult living donor liver transplantation in combination with portal pressure control. Beginning December 2007, the acceptable limit for GRWR was lowered to ≥0.7% and by April 2009, it was further lowered to ≥0.6%. A portal pressure control program targeting a final portal pressure <15 mm Hg was also introduced. The donor complication rate decreased from 13.8% to 9.3%. The overall survival of recipients with GRWR <0.8% did not differ from recipients with a GRWR ≥0.8%. In conclusion, the lower limit of the GRWR can be safely reduced to 0.6% using a left lobe graft in adult-to-adult living donor liver transplantation in combination with portal pressure control.