title: Size mismatch in liver transplantation.
abstract: Size mismatch is an unique and inevitable but critical issue in live donor liver transplantation. Unmatched metabolic demand of recipient as well as physiologic mismatch aggravates the damage to liver graft, inevitably leading to graft failure on recipient. Also, an excessive resection of liver graft for better recipient outcome in live donor liver transplant may jeopardize the healthy donor well-being and even put donor life in danger. There is a fine balance between resected graft volume required to meet the recipient's metabolic demand and residual graft volume required for donor safety. The obvious clinical necessity of finding that balance has prompted a clinical need and promoted the improvement of knowledge and development of management strategies for size-mismatched transplants. The development of the size-matching methodology has significantly improved graft outcome and recipient survival in live donor liver transplants. On the other hand, the effect of size mismatch in cadaveric transplants has never been observed as being so pronounced. The importance of matching of the donor recipient size has been unrecognized in cadaveric liver transplant. In this review, we attempt to summarize the current most updated knowledge on the subject, particularly addressing the definition and complications of size-mismatched cadaveric liver transplant, as well as management strategies.
authors.affiliation: Division of Transplantation, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, Washington 98195, USA. fukazawa@uw.edu.
authors.forename: Kyota
authors.initials: K
authors.lastname: Fukazawa
authors.affiliation: Division of Liver and Gastrointestinal Transplant, Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA.
authors.forename: Seigo
authors.initials: S
authors.lastname: Nishida
mesh_terms: D046148:Donor Selection / Q000379:methods*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008099:Liver / Q000033:anatomy & histology* / Q000378:metabolism; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D009929:Organ Size; D011379:Prognosis; D018570:Risk Assessment; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*
keywords: Graft outcome; Graft weight-to-recipient body weight ratio; Large for size; Size mismatch; Small-for-size; Standard liver volume