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Small‐for‐size graft, small‐for‐size syndrome and inflow modulation in living donor liver transplantation
Author(s) -
Ikegami Toru,
Onda Shinji,
Furukawa Kenei,
Haruki Koichiro,
Shirai Yoshihiro,
Gocho Takeshi
Publication year - 2020
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.822
Subject(s) - medicine , liver transplantation , living donor liver transplantation , transplantation , portal venous pressure , surgery , shunt (medical) , portal hypertension , cirrhosis
Abstract The extended application of living donor liver transplantation (LDLT) has revealed the problem of graft size mismatching called “small‐for‐size syndrome (SFSS).” The initial trials to resolve this problem involved increasing the procured graft size, from left to right, and even extending 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 (GV) such as auxiliary or dual liver transplantation, but also control of the increased portal pressure caused by a small‐for‐size graft (SFSG), such as a porto‐systemic shunt or splenectomy and optimal outflow reconstruction, have been trialed with some positive results. To establish an effective strategy for transplanting SFSG and preventing SFSS, it is essential to have precise knowledge and tactics to evaluate graft quality and GV, when performing these LDLTs with portal pressure control and good venous outflow. Thus, we reviewed the updated literature on the pathogenesis of and strategies for using SFSG.