title: Small-for-size syndrome in living-donor liver transplantation using a left lobe graft.
abstract: In living-donor liver transplantation with a left lobe graft, which can reduce the burden on the donor compared to right lobe graft, the main problem is small-for-size (SFS) syndrome. SFS syndrome is a multifactorial disease that includes aspects related to the graft size, graft quality, recipient factors and even technical issues. The main pathophysiology of SFS syndrome is the sinusoidal microcirculatory disturbance induced by shear stress, which is caused by excessive portal inflow into the smaller graft. The donor age, the presence of steatosis of the graft and a poor recipient status are all risk factors for SFS syndrome. To resolve SFS syndrome, portal inflow modulation, splenectomy, splenic artery modulation and outflow modulation have been developed. It is important to establish strict criteria for managing SFS syndrome. Using pharmacological interventions and/or therapeutic approaches that promote liver regeneration could increase the adequate outcomes in SFS liver transplantation. Left lobe liver transplantation could be adopted in Western countries to help resolve the organ shortage.
authors.affiliation: Division of Gastroenterologic and General Surgery, Department of Surgery, Asahikawa Medical College, 2-1 Midorigaoka-Higashi, Asahikawa, 078-8510, Japan, tonny@isis.ocn.ne.jp.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Taniguchi
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Shimamura
authors.forename: Satoru
authors.initials: S
authors.lastname: Todo
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Furukawa
mesh_terms: D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D008099:Liver / Q000033:anatomy & histology* / Q000601:surgery*; D008102:Liver Circulation; D008115:Liver Regeneration / Q000502:physiology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods*; D019520:Living Donors; D009929:Organ Size; D011169:Portal Vein / Q000601:surgery; D012307:Risk Factors; D013157:Splenic Artery / Q000601:surgery; D013577:Syndrome; D016896:Treatment Outcome