title: Current concept of small-for-size grafts in living donor liver transplantation.
abstract: The extended application of living donor liver transplantation (LDLT) has revealed the problem of graft size mismatching called "small-for-size (SFS) graft syndrome." The initial trials to resolve this problem involved increasing the procured graft size, from left to right, and even extension to include a right lobe graft. Clinical cases of living right lobe donations have been reported since then, drawing attention to the risks of increasing the liver volume procured from a living donor. However, not only other modes of increasing graft volume such as auxiliary or dual liver transplantation, but also control of the increased portal pressure caused by an SFS graft, such as a portosystemic shunt or splenectomy, have been trialed with some positive results. To establish an effective strategy for transplanting SFS grafts and preventing SFS graft syndrome, it is essential to have precise knowledge and tactics to evaluate graft quality and graft volume, when performing these LDLTs with portal pressure control. We reviewed the updated literature on the pathogenesis of and strategies for using SFS grafts.
authors.affiliation: Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Ikegami
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.forename: Satoru
authors.initials: S
authors.lastname: Imura
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Arakawa
authors.forename: Akira
authors.initials: A
authors.lastname: Nii
authors.forename: Yuji
authors.initials: Y
authors.lastname: Morine
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kanemura
mesh_terms: D006801:Humans; D008107:Liver Diseases / Q000209:etiology / Q000503:physiopathology*; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D009929:Organ Size