Small for size syndrome (SFSS) is a clinical syndrome caused by the transplantation of a liver graft that is too small for a recipient. It occurs when the graft to recipient weight ratio (GRWR) is less than 0.8% or a graft volume to standard liver volume ratio (GV/SLV) is less than 35%.
On this page:
Clinical presentation
Clinical presentation includes many non-specific signs and symptoms including:
- persistent elevation of bilirubin level
- large amount of ascites in early post-operative period
- coagulopathy
- gastrointestinal bleeding
- encephalopathy and renal failure in severe cases
Pathology
The small for size syndrome occurs due to an imbalance between rapid liver regeneration and increased demand of liver to perform its function. It is believed to be related to both factors in the donor graft and recipient, listed below.
Graft-related factors
- high portal inflow
- low venous outflow
- pre-existing steatosis in the donor graft
- advanced donor age
- warm and cold ischemia times
Recipient-related factors
- severe preoperative end-stage liver disease
- poor health status
Treatment and prognosis
The literature suggests that controlling graft inflow and outflow is beneficial.
This control can be accomplished in several ways:
- control adequate portal inflow by several methods e.g. splenectomy, splenic artery embolization, splenic artery ligation, mesocaval or portocaval shunts
- control hepatic vein outflow by preservation of any short hepatic vein >0.5 cm and anastomosing it with inferior vena cava
Unable to process the form. Check for errors and try again.