Small for size syndrome (liver graft)
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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%.
Clinical presentation includes many non-specific signs and symptoms including:
- persistent elevation of bilirubin level
- large amount of ascites in early post-operative period
- gastrointestinal bleeding
- encephalopathy and renal failure in severe cases
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.
- high portal inflow
- low venous outflow
- pre-existing steatosis in the donor graft
- advanced donor age
- warm and cold ischemia times
- 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:
- 1. Small‐for‐size liver syndrome after auxiliary and split liver transplantation: Donor selection. (2003) Liver Transplantation. 9 (9): S26. doi:10.1053/jlts.2003.50197 - Pubmed
- 2. Small for size syndrome difficult dilemma: Lessons from 10 years single centre experience in living donor liver transplantation. (2017) World Journal of Hepatology. 9 (21): 930. doi:10.4254/wjh.v9.i21.930 - Pubmed