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Review of the surgical approach to prevent small-for-size syndrome in recipients after left lobe adult LDLT

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Abstract

Left lobe liver grafts increase the donor safety in adult-to-adult living-donor liver transplantation (ALDLT). However, the left lobe graft provides about 30–50 % of the required liver volume to adult recipients, which is insufficient to sustain their metabolic demands, which can lead to small-for-size syndrome (SFSS). Transient portal hypertension and microcirculatory hemodynamic derangement, apart from outflow obstruction, during the first week after reperfusion are the critical events associated with small-for-size graft transplantation. The incidence of SFSS in left lobe ALDLT can be decreased by increasing the left lobe graft volume by effective utilization of the caudate lobe with preserved vascular supply, by modulating the portal pressure with splenectomy or a porto-systemic shunt or by hepatic venous outflow reconstruction to prevent the development of venous congestion. In this review, we discuss the pathophysiology of SFSS and the various surgical strategies that can be performed to prevent SFSS in an effort to enhance the donor safety during living-donor liver transplantation.

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Abbreviations

SFSS:

Small-for-size syndrome

ALDLT:

Adult living-donor liver transplantation

SFS:

Small-for-size

HPCS:

Hemiportocaval shunt

SAE:

Splenic artery embolization

LHV:

Left hepatic vein

MHV:

Middle hepatic vein

GRWR:

Graft–recipient weight ratio

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  1. Graduate School of Medicine, Kyoto University, 54- Kawara-cho, Sakyo-ku, Kyoto City, Kyoto, Japan

    Vikram Raut & Shinji Uemoto

  2. Departments of HPB Surgery and Transplantation, Hospital Beaujon, University Paris VII, Paris, France

    Vikram Raut, Ruslan Alikhanov & Jacques Belghiti

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  1. Vikram Raut
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Raut, V., Alikhanov, R., Belghiti, J. et al. Review of the surgical approach to prevent small-for-size syndrome in recipients after left lobe adult LDLT. Surg Today 44, 1189–1196 (2014). https://doi.org/10.1007/s00595-013-0658-6

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