Octreotide vs. Splenic Artery Ligation for Portal Flow Modulation in Living Donor Liver Transplants (SCALOP Trial)

Median Comprehensive Complication Index® (CCI®)

Time frame · From the day of liver transplantation (Day 0) through postoperative day 90.

The Comprehensive Complication Index® (CCI®) is a validated, quantitative metric that reflects the cumulative burden of postoperative complications by integrating all complications experienced by a patient into a single continuous scale (range: 0 (no complications) to 100 (death)). The CCI® is calculated using the Clavien-Dindo Classification to grade the severity of each complication (Grades I-V), with weights assigned based on clinical impact.

Small-for-size syndrome (SFSS) rate

Time frame · From the day of liver transplantation (Day 0) through postoperative day 14

SFSS is a clinically defined syndrome occurring in recipients of small-for-size liver grafts (graft-to-recipient weight ratio (GRWR) \<0.80%), characterized by: * Persistent cholestasis (serum total bilirubin \>5.8 mg/dL beyond postoperative day 14) * Refractory ascites (daily ascitic fluid output \>1 L despite diuretics beyond day 14) * Coagulopathy (INR \>2 with hypoalbuminemia \<2.5 g/dL beyond day 14) Diagnostic Criteria * Requires ≥2 of the above features (per ILTS-iLDLT-LTSI 2023 Consensus Guidelines). * Excludes other causes of graft dysfunction (e.g., hepatic artery thrombosis, acute rejection).

Number and proportion of postoperative complication types and grades within 90 days

Time frame · From the day of liver transplantation (Day 0) through postoperative day 90

All complications occurring within 90 days post-transplantation will be prospectively recorded and graded using the Clavien-Dindo Classification, a validated system for surgical morbidity. * Grade I: Minor deviations (e.g., antipyretics for fever, bedside wound care). * Grade II: Pharmacological treatment (e.g., antibiotics for infection). * Grade III: Surgical/endoscopic intervention (IIIa: local anesthesia; IIIb: general anesthesia). * Grade IV: Life-threatening (IVa: single-organ dysfunction; IVb: multi-organ failure). * Grade V: Death.

Adequate portal flow modulation response rate

Time frame · From intervention completion (T=0) to 60 minutes post-intervention

The proportion of patients achieving target hemodynamic parameters following intervention (octreotide or splenic artery ligation), defined as: * Portal venous flow (PVF) \<5 mL/min/graft weight and * Presence of diastolic hepatic arterial flow on Doppler ultrasound post-intervention.

Mortality rate

Time frame · From the day of liver transplantation (Day 0) through postoperative day 90

All-cause mortality occurring within 90 days post-transplantation, regardless of relationship to the intervention or underlying liver disease. This will the proportion of deaths over total number of patients within each arm and reported in percentage.

Median portal venous flow (PVF) rate on intraoperative Liver Doppler ultrasound

Time frame · Intraoperative (post-reperfusion) and postoperative (daily) timepoints until day 20 postoperatively or hospital discharge

Portal venous flow (PVF): Volume flow rate (mL/min) normalized to graft weight (mL/min/g)

Median Hepatic artery resistive index (RI) on intraoperative Liver Doppler ultrasound

Time frame · Intraoperative (post-reperfusion) and postoperative (daily) timepoints until day 20 postoperatively or hospital discharge

Hepatic artery resistive index (RI): (Peak systolic velocity - End diastolic velocity)

Hepatic artery diastolic flow rate

Time frame · Intraoperative (post-reperfusion) and postoperative (daily) timepoints until day 20 postoperatively or hospital discharge

Binary presence or absence rate of end- diastolic flow on Liver Doppler Ultrasound

Median intensive care unit length of stay in days

Time frame · Days from admission to the Intensive Care Unit (ICU) (typically Day 0 to Day 4 postoperatively) until ICU discharge to the surgical ward.

Total number of days in the Intensive care unit (ICU) during the primary admission, from the day of transplant (Day 0) until discharge to the surgical ward.

Median hospital length of stay in days

Time frame · From the day of liver transplantation (Day 0) until hospital discharge (typically day 20 postoperatively)

Total number of days patient hospitalized during the index procedure

Graft survival rate at 1-year post-transplantation

Time frame · From the day of liver transplantation (Day 0) through postoperative day 365

The proportion of patients with a functional liver graft (alive without retransplantation) at 1 year post-transplant, analyzed by including all graft losses (death or retransplantation) using the Kaplan-Meier test.

Patient survival rate at 1-year post-transplantation

Time frame · From the day of liver transplantation (Day 0) through postoperative day 365

The proportion of patients with alive at 1 year post-transplant, analyzed using the Kaplan-Meier test.

Quality of Life Assessment (36-Item Short Form Health Survey, SF-36) (median values)

Time frame · Measured at baseline (pre-transplant), 3 months, 6 months, and 12 months post-transplantation.

The 36-Item Short Form Health Survey (SF-36) is a validated patient-reported outcome measure that assesses health-related quality of life. The SF-36 consists of eight subscales, which are further summarized into two component scores: * Physical Component Summary (PCS): Includes physical functioning, role-physical, bodily pain, and general health. * Mental Component Summary (MCS): Includes vitality, social functioning, role-emotional, and mental health. Scoring: Each subscale is scored from 0 to 100, where higher scores indicate better health-related quality of life. The median scores will be compared between the two groups.