Small-for-size syndrome in liver transplantation: Definition, pathophysiology and management

• 作者: Akira Shimizu Atsuyoshi Mita Kazuki Yoshizawa Yasunari Ohno Yuichi Masuda Yuji Soejima
• 来源期刊: 国际肝胆胰疾病杂志(英文版)
• 年，卷（期）: 2020,（4）
• 页码范围: 334-341
• 页数: 8页
• 语种: 英文

摘要

Background: Since the first success in an adult patient, living donor liver transplantation (LDLT) has be- come an universally used procedure. Small-for-size syndrome (SFSS) is a well-known complication after partial LT, especially in cases of adult-to-adult LDLT. The definition of SFSS slightly varies among trans- plant physicians. The use of a partial liver graft has risks of SFSS development. Persistent portal vein (PV) hypertension and PV hyper-perfusion after LT were identified as the main factors. Hence, various approaches were explored to modulate PV flow and decrease PV pressure in order to alleviate this syn- drome. Herein, the definition, clinical symptoms, pathophysiology, basic research, as well as preventive and treatment strategies for SFSS are reviewed based on an extensive review of the literature and on our own experiences.Data sources: The articles were collected through PubMed using search terms "liver transplantation", "liv- ing donor liver transplantation", "living liver donation", "partial graft", "small-for-size graft", "small-for- size syndrome", "graft volume", "remnant liver", "standard liver volume", "graft to recipient body weight ratio", "sarcopenia", "porcine", "swine", and "rat". English publications published before March 31, 2020 were included in this review. Results: Many transplant surgeons performed PV flow modulation, including portocaval shunt, splenic artery ligation and splenectomy. With these techniques, patient outcome has been improved even when using a "small" graft. Other factors, such as preoperative recipients' nutritional and skeletal muscle status, graft congestion, and donor factors, were also identified as risk factors which all have been addressed using various strategies. Conclusions: The surgical approach controlling PV flow and pressure could help to prevent SFSS espe- cially in severely ill recipients. In the absence of efficacious medications to resolve SFSS, conservative treatments, including aggressive fluid balance correction for massive ascites, anti-microbiological ther- apy to prevent or control sepsis and intensive nutritional therapy, are all required if SFSS could not be prevented.