Graft-to-recipient weight ratio exerts nonlinear effects on prognosis by interacting with donor liver macrosteatosis

Zhengtao Liu; Jingting Lyu; Xiang Li; Lu Yu; Shuping Que; Jun Xu; Lei Geng; Shusen Zheng

doi:10.3389/fsurg.2022.1075845

Graft-to-recipient weight ratio exerts nonlinear effects on prognosis by interacting with donor liver macrosteatosis

Front Surg. 2023 Jan 17:9:1075845. doi: 10.3389/fsurg.2022.1075845. eCollection 2022.

Authors

Zhengtao Liu^{1

2

3

4}, Jingting Lyu¹, Xiang Li^{2

5}, Lu Yu^{4

6}, Shuping Que⁷, Jun Xu^{2

5}, Lei Geng^{2

5}, Shusen Zheng^{1

2

3

4

5}

Affiliations

¹ Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China.
² NHC Key Laboratory of Combined Multi-Organ Transplantation, Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
³ Key Laboratory of Organ Transplantation, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
⁴ Shulan (Hangzhou) Hospital, Hangzhou, China.
⁵ Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
⁶ School of Medicine, Zhejiang Chinese Medical University, Hangzhou, China.
⁷ DingXiang Clinics, Hangzhou, China.

Abstract

Aim: To investigate the interactions between the graft-to-recipient weight ratio (GWRWR) and other risk factors responsible for inferior allograft outcomes.

Methods: A total of 362 patients who received liver transplantation (LT) were enrolled. Indicators such as graft/recipient weight and other prognostic factors were collected. Comparisons of indicators and survival analysis were performed in groups categorized by the GWRWR. Interactions of large-for-size grafts (LFSGs) with graft macrosteatosis (MaS) were evaluated in terms of relative excess risk caused by interaction (RERI) and attributable proportion (AP). Cytoscape visualized the role of LFSGs in the risk profile for poor prognosis.

Results: Based on the GWRWR, LT cases can be categorized into three subgroups, standard (1%-2.5%), optimal (2.5%-3.0%), and inferior prognosis (>3.0%). Survival analysis confirmed clear separations in cases categorized by the above-defined limits on the GWRWR (P < 0.05). LFSGs caused inferior prognosis by initiating positive interactions with MaS severity.

Conclusion: The GWRWR exerted nonlinear effects on prognosis in deceased donor LT cases. LFSGs (GWRWR > 3.0%) caused inferior outcomes, while grafts sized within (2.5%-3.0%) had optimal post-transplant prognosis. MaS increased the risk of poor prognosis by exerting positive synergistic effects on LFSGs.

Keywords: GWRWR; graft failure; liver transplantation; macrosteatosis; prognosis.

Grants and funding

This study is supported by the Innovative Research Groups of National Natural Science Foundation of China (grant no. 81721091), the Major program of National Natural Science Foundation of China (grant no. 91542205), the National S&T Major Project (grant no. 2017ZX10203205), the National Natural Science Foundation of China (grant no. 81902813), the Zhejiang International Science and Technology Cooperation Project (grant no. 2016C04003), the Zhejiang Provincial Natural Science Foundation of China (grant no. LY22H030008), the Zhejiang Medical Association (grant no. 2019ZYC-A81), the International Youth Exchange Programme by China Association for Science and Technology (2019), the Tianqing Liver Diseases Research Fund (grant no. TQGB20200114), the Organ Transplantation Overseas Training for Youth Talents from Shulan Excellent Talent Project, CSCO (Chinese Society Of Clinical Oncology)-Bayer Tumor Research Funding (Y-bayer202001/zb-0003), the Chen Xiao-ping Foundation for the Development of Science and Technology of Hubei Province (grant no. CXPJJH122002-078), and the Beijing iGandan Foundation (grant no. 1082022-RGG022).