Predictive Value of Small for Size Syndrome and Surveillance of Graft Functions in Adult Living Donor Liver Transplantation

Abstract

SFSS is a recognizable clinical syndrome, occurs in the presence of a reduced mass of liver, which is insufficient to maintain normal liver function and was first described in liver transplantation. A definition has yet to be fully clarified, but the syndrome is characterized by postoperative liver dysfunction with prolonged cholestasis and coagulopathy, portal hypertension, and if severe with ascites. Furthermore, the liver dysfunction predisposes to further complications including encephalopathy, gastrointestinal bleeding, renal failure and sepsis (Tucker and Heaton, 2005). Although different hypotheses have been proposed to explain pathogenesis of SFSS, many questions remain not answered. The increase in portal pressure and mesenteric flow cause sinusoidal endothelial and Kupffer cell injury with release of inflammatory cytokines. This results in parenchymal loss, a reduced intrahepatic vascular bed, increased hepatic portal resistance due to transient sinusoidal narrowing with higher portal flow per gram of remnant liver (Fu et al., 2011). To avoid small for size graft (SFSG), a larger sized graft, such as the right lobe graft, is used as the standard strategy for adult-to-adult LDLT. However, although a right lobe LDLT can provide an adequate graft size to meet the metabolic demands of most adult recipients, SFSS can be observed not only in SFSG recipients but also in larger