title: [Pathophysiology and strategy for small-for-size graft syndrome after living-donor liver transplantation].
abstract: Small-for-size (SFS) graft syndrome is an important problem after living-donor liver transplantation in adults. Hemodynamic change is thought to be the main cause of graft injury. Excessive portal flow is associated with hepatic sinusoidal injury, and reduction of portal flow improves postoperative liver function. Increased venous outflow due to hepatic venoplasty or reconstruction of the middle hepatic vein decrease the risk of graft congestion. However, the intragraft acute-phase response remains unclear. Recent studies have revealed that downregulation of heat shock protein (HSP) may account for SFS graft injury, and induction of HSP may prevent SFS syndrome. On the other hand, derangement in the regulation of liver regeneration is recognized as another important factor. Further investigation of the regulatory mechanisms of liver regeneration in SFS grafts may suggest a strategy for the prevention and treatment of SFS syndrome. Successful transplantation of marginal-size liver grafts would improve outcome for recipients and increase the margin of safety for living donors.
authors.affiliation: Department of Digestive Pediatric Surgery, University of Tokushima School of Medicine, Tokushima, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Fujii
authors.forename: Satoru
authors.initials: S
authors.lastname: Imura
authors.forename: Yuji
authors.initials: Y
authors.lastname: Morine
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ikemoto
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
mesh_terms: D028341:Activins / Q000502:physiology; D038681:Follistatin / Q000502:physiology; D006085:Graft Survival; D006360:Heat-Shock Proteins / Q000378:metabolism; D006801:Humans; D008099:Liver / Q000033:anatomy & histology* / Q000378:metabolism; D017093:Liver Failure / Q000209:etiology* / Q000517:prevention & control*; D008115:Liver Regeneration / Q000502:physiology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods*; D019520:Living Donors; D009929:Organ Size; D011169:Portal Vein / Q000502:physiology; D012039:Regional Blood Flow; D013577:Syndrome
chemical_list: D038681:Follistatin; D006360:Heat-Shock Proteins; D028341:Activins