Skip to main content
SpringerLink
Log in

Issues in Management of Small for Size Syndrome in Live Donor Liver Transplantation

  • Chapter
  • First Online:
GI Surgery Annual

Part of the book series: GI Surgery Annual ((GISA,volume 22))

  • 360 Accesses

Abstract

Adult-to-adult living donor liver transplantation (LDLT) has gained widespread acceptance. LDLT grafts are from well-selected donors and less likely than deceased donor grafts to suffer from reperfusion injury. However, smaller grafts might have a deleterious effect on outcomes in heavy recipients. Most transplant centres currently follow the rule of a graft-to-recipient weight ratio (GRWR) >0.8 or a graft weight (GW)/standard liver volume (SLV) ratio >40 % [1–4].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Selzner M, Kashfi A, Cattral MS, Selzner N, Greig PD, Lilly L, et al. A graft to body weight ratio less than 0.8 does not exclude adult-to-adult right-lobe living donor liver transplantation. Liver Transpl 2009;15:1776–82.

    Article  PubMed  Google Scholar 

  2. Marcos A. Right lobe living donor liver transplantation: A review. Liver Transpl 2000;6:3–20.

    Article  CAS  PubMed  Google Scholar 

  3. Tuttle-Newhall JE, Collins BH, Desai DM, Kuo PC, Heneghan MA. The current status of living donor liver transplantation. Curr Probl Surg 2005;42:144–83.

    Article  PubMed  Google Scholar 

  4. Brown RS Jr. Live donors in liver transplantation. Gastroenterology 2008;134:1802–13.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Kiuchi T, Kasahara M, Uryuhara K, Inomata Y, Uemoto S, Asonuma K, et al. Impact of graft size mismatching on graft prognosis in liver transplantation from living donors. Transplantation 1999;67:321–7.

    Article  CAS  PubMed  Google Scholar 

  6. Fan ST, Lo CM, Liu CL, Yong BH, Wong J. Determinants of hospital mortality of adult recipients of right lobe live donor liver transplantation. Ann Surg 2003;238:864–9.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Shimada M, Ijichi H, Yonemura Y, Harada N, Shiotani S, Ninomiya M, et al. Is graft size a major risk factor in living-donor adult liver transplantation? Transpl Int 2004;17:310–16.

    Article  CAS  PubMed  Google Scholar 

  8. Hill MJ, Hughes M, Jie T, Cohen M, Lake J, Payne WD, et al. Graft weight/recipient weight ratio: how well does it predict outcome after partial liver transplants? Liver Transpl 2009;15:1056–62.

    Article  PubMed  Google Scholar 

  9. Takeda K, Tanaka K, Kumamoto T, Nojiri K, Mori R, Taniguchi K, et al. Emergency versus elective living-donor liver transplantation: A comparison of a single center analysis. Surg Today 2012;42:453–9.

    Article  PubMed  Google Scholar 

  10. Dahm F, Georgiev P, Clavien PA. Small-for-size syndrome after partial liver transplantation: definition, mechanisms of disease and clinical implications. Am J Transplant 2005;5:2605–10.

    Article  PubMed  Google Scholar 

  11. Soejima Y, Shimada M, Suehiro T, Hiroshige S, Ninomiya M, Shiotani S, et al. Outcome analysis in adult-to-adult living donor liver transplantation using the left lobe. Liver Transpl 2003;9:581–6.

    Article  PubMed  Google Scholar 

  12. Wani M, Balachandran P, Rastogi A, Goja S, Bangui P, Ramachandra S, et al. Performance status—The key to survival in GRWR <0.7. Transplantation 2015;99:S99.

    Google Scholar 

  13. Man K, Fan ST, Lo CM, Liu CL, Fung PC, Liang TB, et al. Graft injury in relation to graft size in right lobe live donor liver transplantation: A study of hepatic sinusoidal injury in correlation with portal hemodynamics and intragraft gene expression. Ann Surg 2003;237:256–64.

    PubMed  PubMed Central  Google Scholar 

  14. Yagi S, Iida T, Taniguchi K, Hori T, Hamada T, Fujii K, et al. Impact of portal venous pressure on regeneration and graft damage after living-donor liver transplantation. Liver Transpl 2005;11:68–75.

    Article  PubMed  Google Scholar 

  15. Fondevila C, Hessheimer AJ, Taurá P, Sánchez O, Calatayud D, de Riva N, et al. Portal hyperperfusion: Mechanism of injury and stimulus for regeneration in porcine small-for-size transplantation. Liver Transpl 2010;16:364–74.

    Article  PubMed  Google Scholar 

  16. Demetris AJ, Kelly DM, Eghtesad B, Fontes P, Wallis Marsh J, Tom K, et al. Pathophysiologic observations and histopathologic recognition of the portal hyperperfusion or small-for-size syndrome. Am J Surg Pathol 2006;30:986–93.

    Article  PubMed  Google Scholar 

  17. Sheiner P, Belghiti J, Gish RG, Miller C. Model for end-stage liver disease (MELD) exception small-for-size syndrome. Liver Transpl 2006;12:S120–1.

    Article  PubMed  Google Scholar 

  18. Liang TB, Man K, Kin-Wah Lee T, Hong-Teng Tsui S, Lo CM, Xu X, et al. Distinct intragraft response pattern in relation to graft size in liver transplantation. Transplantation 2003;75:673–8.

    Article  CAS  PubMed  Google Scholar 

  19. Paulsen AW, Klintmalm GB. Direct measurement of hepatic blood flow in native and transplanted organs, with accompanying systemic hemodynamics. Hepatology 1992;16:100–11.

    Article  CAS  PubMed  Google Scholar 

  20. Shimamura T, Taniguchi M, Jin MB, Suzuki T, Matsushita M, Furukawa H, et al. Excessive portal venous inflow as a cause of allograft dysfunction in small-for-size living donor liver transplantation. Transplant Proc 2001; 33: 13–31.

    Article  Google Scholar 

  21. Troisi R, Cammu G, Militerno G, De Baerdemaeker L, Decruyenaere J, Hoste E, et al. Modulation of portal graft inflow: A necessity in adult living-donor liver transplantation? Ann Surg 2003;237:429–36.

    PubMed  PubMed Central  Google Scholar 

  22. Niiya T, Murakami M, Aoki T, Murai N, Shimizu Y, Kusano M. Immediate increase of portal pressure, reflecting sinusoidal shear stress, induced liver regeneration after partial hepatectomy. J Hepatobiliary Pancreat Surg 1999;6:275–80.

    Article  CAS  PubMed  Google Scholar 

  23. Yoshizumi T, Taketomi A, Uchiyama H, Harada N, Kayashima H, Yamashita Y, et al. Graft size, donor age, and patient status are the indicators of early graft function after living donor liver transplantation. Liver Transpl 2008;14:1007–13.

    Article  PubMed  Google Scholar 

  24. Nadalin S, Malagò M, Radtke A, Erim Y, Saner F, Valentin-Gamazo C, et al. Current trends in live liver donation. Transpl Int 2007;20:312–30.

    Article  PubMed  Google Scholar 

  25. Kiuchi T, Tanaka K, Ito T, Oike F, Ogura Y, Fujimoto Y, et al. Small-for-size graft in living donor liver transplantation: How far should we go? Liver Transpl 2003;9:S29–35.

    Article  PubMed  Google Scholar 

  26. Morioka D, Egawa H, Kasahara M, Ito T, Haga H, Takada Y, et al. Outcomes of adult-to-adult living donor liver transplantation: A single institution’s experience with 335 consecutive cases. Ann Surg 2007;245:315–25.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Olthoff KM, Merion RM, Ghobrial RM, Abecassis MM, Fair JH, Fisher RA, et al. A2ALL Study Group. Outcomes of 385 adult-to-adult living donor liver transplant recipients: A report from the A2ALL Consortium. Ann Surg 2005;242:314–23.

    PubMed  PubMed Central  Google Scholar 

  28. Yoshizumi T, Taketomi A, Soejima Y, Uchiyama H, Ikegami T, Harada N, et al. Impact of donor age and recipient status on left-lobe graft for living donor adult liver transplantation. Transpl Int 2008;21:81–8.

    Article  CAS  PubMed  Google Scholar 

  29. Moon JI, Kwon CH, Joh JW, Jung GO, Choi GS, Park JB, et al. Safety of small-for-size grafts in adult-to-adult living donor liver transplantation using the right lobe. Liver Transpl 2010;16:864–9.

    Article  PubMed  Google Scholar 

  30. Chan SC, Lo CM, Ng KK, Fan ST. Alleviating the burden of small-for-size graft in right liver living donor liver transplantation through accumulation of experience. Am J Transplant 2010;10:859–67.

    Article  CAS  PubMed  Google Scholar 

  31. Dirsch O, Madrahimov N, Chaudri N, Deng M, Madrahimova F, Schenk A, et al. Recovery of liver perfusion after focal outflow obstruction and liver resection. Transplantation 2008;85:748–56.

    Article  PubMed  Google Scholar 

  32. Fan ST, Lo CM, Liu CL, Wang WX, Wong J. Safety and necessity of including the middle hepatic vein in the right lobe graft in adult-to-adult live donor liver transplantation. Ann Surg 2003;238:137–48.

    PubMed  PubMed Central  Google Scholar 

  33. Gyu Lee S, Min Park K, Hwang S, Hun Kim K, Nak Choi D, Hyung Joo S, et al. Modified right liver graft from a living donor to prevent congestion. Transplantation 2002;74:54–9.

    Article  PubMed  Google Scholar 

  34. Hashimoto T, Sugawara Y, Kishi Y, Akamatsu N, Matsui Y, Kokudo N, et al. Reconstruction of the middle hepatic vein tributary in a right lateral sector graft. Liver Transpl 2005;11:309–13.

    Article  PubMed  Google Scholar 

  35. Lei JY, Wang WT, Yan LN. Risk factors of SFSS in adult-to-adult living donor liver transplantation using the right liver: A single-center analysis of 217 cases. Hepatogastroenterology 2012;59:1491–7.

    PubMed  Google Scholar 

  36. Lo CM, Fan ST, Liu CL, Yong BH, Wong Y, Lau GK, et al. Lessons learned from one hundred right lobe living donor liver transplants. Ann Surg 2004;240:151–8.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Kasahara M, Takada Y, Fujimoto Y, Ogura Y, Ogawa K, Uryuhara K, et al. Impact of right lobe with middle hepatic vein graft in living-donor liver transplantation. Am J Transplant 2005;5:1339–46.

    Article  PubMed  Google Scholar 

  38. Ben-Haim M, Emre S, Fishbein TM, Sheiner PA, Bodian CA, Kim-Schluger L, et al. Critical graft size in adult-to-adult living donor liver transplantation: Impact of the recipient’s disease. Liver Transpl 2001;7:948–53.

    Article  CAS  PubMed  Google Scholar 

  39. Eshkenazy R, Dreznik Y, Lahat E, Zakai BB, Zendel A, Ariche A. Small for size liver remnant following resection: Prevention and management. Hepatobiliary Surg Nutr 2014;3:303–12.

    PubMed  PubMed Central  Google Scholar 

  40. Soejima Y, Shirabe K, Yoshizumi T, Uchiyama H, Ikegami T, Taketomi A, et al. Small-for size syndrome. In: Busuttil RW, Klintmalm GB (eds). Transplantation of the liver. 3rd ed. New York:Elsevier; 2015:719–28.

    Google Scholar 

  41. Miyagawa S, Hashikura Y, Miwa S, Ikegami T, Urata K, Terada M, et al. Concomitant caudate lobe resection as an option for donor hepatectomy in adult living related liver transplantation. Transplantation 1998;66:661–3.

    Article  CAS  PubMed  Google Scholar 

  42. Takayama T, Makuuchi M, Kubota K, Sano K, Harihara Y, Kawarasaki H. Living-related transplantation of left liver plus caudate lobe. J Am Coll Surg 2000;190:635–8.

    Article  CAS  PubMed  Google Scholar 

  43. Kaido T, Mori A, Ogura Y, Hata K, Yoshizawa A, Iida T, et al. Lower limit of the graft-to-recipient weight ratio can be safely reduced to 0.6% in adult-to-adult living donor liver transplantation in combination with portal pressure control. Transplant Proc 2011;43:2391–3.

    Google Scholar 

  44. Yamada T, Tanaka K, Uryuhara K, Ito K, Takada Y, Uemoto S. Selective hemi-portocaval shunt based on portal vein pressure for small-for-size graft in adult living donor liver transplantation. Am J Transplant 2008;8:847–53.

    Article  CAS  PubMed  Google Scholar 

  45. Botha JF, Langnas AN, Campos BD, Grant WJ, Freise CE, Ascher NL, et al. Left lobe adult-to-adult living donor liver transplantation: Small grafts and hemiportocaval shunts in the prevention of small-for-size syndrome. Liver Transpl 2010;16:649–57.

    Article  PubMed  Google Scholar 

  46. Schoen JM, Wang HH, Minuk GY, Lautt WW. Shear stress-induced nitric oxide release triggers the liver regeneration cascade. Nitric Oxide 2001;5:453–64.

    Article  CAS  PubMed  Google Scholar 

  47. Botha JF, Campos BD, Johanning J, Mercer D, Grant W, Langnas A. Endovascular closure of a hemiportocaval shunt after small-for-size adult-to-adult left lobe living donor liver transplantation. Liver Transpl 2009;15:1671–5.

    Article  PubMed  Google Scholar 

  48. Sato Y, Yamamoto S, Takeishi T, Kato T, Nakatsuka H, Kobayashi T, et al. Inferior mesenteric venous left renal vein shunting for decompression of excessive portal hypertension in adult living related liver transplantation. Transplant Proc 2004;36:2234–6.

    Article  CAS  PubMed  Google Scholar 

  49. Soin AS. Smoothing the path: Reducing biliary complications, addressing small-for-size syndrome, and making other adaptations to decrease the risk for living donor liver transplant recipients. Liver Transpl 2012;18:S20–S24.

    Article  PubMed  Google Scholar 

  50. Kanazawa H, Takada Y, Ogura Y, Oike F, Egawa H, Uemoto S. Mesorenal shunt using inferior mesenteric vein and left renal vein in a case of LDLT. Transpl Int 2009;22:1189–92.

    Article  PubMed  Google Scholar 

  51. Sato Y, Yamamoto S, Takeishi T, Hirano K, Kobayashi T, Kato T, et al. Management of major portosystemic shunting in small-for-size adult living-related donor liver transplantation with a left-sided graft liver. Surg Today 2006;36:354–60.

    Article  PubMed  Google Scholar 

  52. Eipel C, Abshagen K, Ritter J, Cantré D, Menger MD, Vollmar B. Splenectomy improves survival by increasing arterial blood supply in a rat model of reduced-size liver. Transpl Int 2010;23:998–1007.

    Article  PubMed  Google Scholar 

  53. Ogura Y, Hori T, El Moghazy WM, Yoshizawa A, Oike F, Mori A, et al. Portal pressure <15 mm Hg is a key for successful adult living donor liver transplantation utilizing smaller grafts than before. Liver Transpl 2010;16:718–28.

    PubMed  Google Scholar 

  54. Pan C, Shi Y, Zhang JJ, Deng YL, Zheng H, Zhu ZJ, et al. Single-center experience of 253 portal vein thrombosis patients undergoing liver transplantation in China. Transplant Proc 2009;41:3761–5.

    Article  CAS  PubMed  Google Scholar 

  55. Samimi F, Irish WD, Eghtesad B, Demetris AJ, Starzl TE, Fung JJ. Role of splenectomy in human liver transplantation under modern-day immunosuppression. Dig Dis Sci 1998;43:1931–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Umeda Y, Yagi T, Sadamori H, Matsukawa H, Matsuda H, Shinoura S, et al. Effects of prophylactic splenic artery modulation on portal overperfusion and liver regeneration in small-for-size graft. Transplantation 2008;86:673–80.

    Article  PubMed  Google Scholar 

  57. Balci D, Taner B, Dayangac M, Akin B, Yaprak O, Duran C, et al. Splenic abscess after splenic artery ligation in living donor liver transplantation: A case report. Transplant Proc 2008;40:1786–8.

    Article  CAS  PubMed  Google Scholar 

  58. Ishizaki Y, Kawasaki S, Sugo H, Yoshimoto J, Fujiwara N, Imamura H. Left lobe adult-to-adult living donor liver transplantation: Should portal inflow modulation be added? Liver Transpl 2012;18:305–14.

    Article  PubMed  Google Scholar 

  59. Emond JC, Heffron TG, Whitington PF, Broelsch CE. Reconstruction of the hepatic vein in reduced size hepatic transplantation. Surg Gynecol Obstet 1993;176:11–17.

    CAS  PubMed  Google Scholar 

  60. Tanaka K, Uemoto S, Tokunaga Y, Fujita S, Sano K, Nishizawa T, et al. Surgical techniques and innovations in living related liver transplantation. Ann Surg 1993;217:82–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. de Villa VH, Chen CL, Chen YS, Wang CC, Wang SH, Chiang YC, et al. Outflow tract reconstruction in living donor liver transplantation. Transplantation 2000;70:1604–8.

    Article  PubMed  Google Scholar 

  62. Soin AS, Mohanka R, Singla P, Piplani T, Menon B, Kakodkar R, et al. Segment IV preserving middle hepatic vein retrieval in right lobe living donor liver transplantation. J Am Coll Surg 2011;213:5–16.

    Article  Google Scholar 

  63. Tanaka K, Kiuchi T, Kaihara S. Living related liver donor transplantation: Techniques and caution. Surg Clin North Am 2004;84:481–93.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medanta Liver Institute, Medanta-The Medicity, Gurgaon, Haryana, India

    A. S. Soin, P. Balachandran & V. Raut

Authors
  1. A. S. Soin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Balachandran
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. V. Raut
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of GI Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India

    Peush Sahni

  2. Department of GI Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India

    Sujoy Pal

Rights and permissions

Reprints and permissions

Copyright information

© 2015 T.K. Chattopadhyay

About this chapter

Cite this chapter

Soin, A.S., Balachandran, P., Raut, V. (2015). Issues in Management of Small for Size Syndrome in Live Donor Liver Transplantation. In: Sahni, P., Pal, S. (eds) GI Surgery Annual. GI Surgery Annual, vol 22. Springer, Singapore. https://doi.org/10.1007/978-981-10-2010-0_9

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-2010-0_9

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-2009-4

  • Online ISBN: 978-981-10-2010-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation