Body surface area index predicts outcome in orthotopic liver transplantation

Kyota Fukazawa, Seigo Nishida, Alex Volsky, Andreas G. Tzakis, Ernesto A. Pretto

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Background/Purpose: In living donor liver transplantation (LDLT), matching of liver volume between donor and recipient is critical to the success of the procedure; mismatch can result in 'small- or large-for-size syndrome'. In orthotopic liver transplantation (OLT), matching criteria are less stringent and non-uniform. We sought to determine whether a new parameter, the ratio of donor to recipient body surface area (BSAi), is predictive of size mismatch and/or post-transplant morbidity or mortality. Methods: We reviewed data on 1228 OLT recipients and stratified this data according to three categories: small-forsize (BSAi<0.6), control (BSAi = 0.6-1.4), and large-forsize (BSAi>1.4) donors. Results: We found that: (1) matching of grafts at the upper and lower extremes of BSAi had significantly reduced graft survival; (2) matches with lower BSAi sustained a less severe form of intraoperative post-reperfusion syndrome, and the incidence of hepatic artery thrombosis was high postoperatively in these grafts; (3) BSAi and donor age correlated well with the severity of intraoperative postreperfusion hypotension; and (4) small-for-size (BSAi <0.6) and large-for-size (BSAi >1.4) grafts, as well as preoperative total bilirubin, were significant risk factors for decreased graft survival. Conclusion: We conclude that the BSAi can predict clinically significant size mismatch and adverse outcomes in cadaveric whole OLT.

Original languageEnglish (US)
Pages (from-to)216-225
Number of pages10
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Issue number2
StatePublished - Mar 1 2011


  • Body surface area
  • Liver transplantation
  • Post-reperfusion syndrome
  • Size mismatch
  • Survival

ASJC Scopus subject areas

  • Hepatology
  • Surgery


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