Prevention and Management of Small-for-Size Syndrome of Liver Transplantation

Abstract

Small-for-size syndrome (SFSS) is a critical complication of LT using a partial graft, particularly in cases of adult-to-adult ALDLT using a small graft (Fig. 1). In general, small-for-size graft (SFSG) corresponds to a graft weight <0.8% of recipient weight or a graft volume <40% of recipient’s standard liver volume (SLV) [5–8]. Recent progress in perioperative care and technical improvement in partial LT, minimally required liver graft volume for successful transplantation is an ongoing debate and has decreased to 0.6% graft versus recipient weight ratio (GRWR) (approximately 25% of the recipient’s SLV). The definition of SFSS varies among transplant centers. Persistent portal hypertension and hyperperfusion after SFSG transplantation have been identified as the main factors in this clinical syndrome [9,10]. Nevertheless, the SFSS is a multifaceted event. Typical clinical manifestations of SFSS are consequences of portal hypertension and graft dysfunction, presenting as more than two of the following on 3 consecu-