Advances in Small-for-Size Syndrome in Living Donor Liver Transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LEI Jianyong , YAN Lnan , WANG Wentao , XU Mingqing , YANG Jiayin.

Department of Liver and Vascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding author：

Keywords：

Living donor liver transplantation; Small-for-size syndrome

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ObjectiveTo review the causes, prevention methods, and therapies of the small-for-size syndrome (SFSS) in living donor liver transplantation (LDLT). MethodsThe literatures about SFSS in recent years were reviewed and summarized. ResultsThe donor’s age, graft steatosis level, MELD score of the recipient, portal hypertension, low outflow, and graft size were risk factors of SFSS. Ideal donor, splenectomy, ligating splenic artery, keeping a satisfactory intraoperative outflow, early diagnosis and active therapy could obviously decrease the incidence of SFSS. ConclusionThe risk factors of SFSS can be predicted before operation, and the positive actions can be used to prevent or cure the SFSS.

Citation： LEI Jianyong,YAN Lnan,WANG Wentao,XU Mingqing,YANG Jiayin.. Advances in Small-for-Size Syndrome in Living Donor Liver Transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(9): 926-930. doi: Copy

1.	Hashikura Y, Makuuchi M, Kawasaki S, et al. Successful livingrelated partial liver transplantation to an adult patient [J]. Lancet, 1994, 343(8907): 12331234.
2.	Kiuchi T, Kasahara M, Uryuhara K, et al. Impact of graft size mismatching on graft prognosis in liver transplantation from living donors [J]. Transplantation, 1999, 67(2): 321327.
3.	Dahm F, Georgiev P, Clavien PA. Smallforsize syndrome after partial liver transplantation: definition, mechanisms of disease and clinical implications [J]. Am J Transplant, 2005, 5(11): 26052610.
4.	Sanefuji K, Iguchi T, Ueda S, et al. New prediction factors of smallforsize syndrome in living donor adult liver transplantation for chronic liver disease [J]. Transpl Int, 2010, 23(4): 350357.
5.	Imura S, Shimada M, Ikegami T, et al. Strategies for improving the outcomes of smallforsize grafts in adulttoadult livingdonor liver transplantation [J]. J Hepatobiliary Pancreat Surg, 2008, 15(2): 102110.
6.	Lo CM, Fan ST, Liu CL, et al. Minimum graft size for successful living donor liver transplantation [J]. Transplantation, 1999, 68(8): 11121116.
7.	Soejima Y, Taketomi A, Yoshizumi T, et al. Feasibility of left lobe living donor liver transplantation between adults: an 8year,singlecenter experience of 107 cases [J]. Am J Transplant, 2006, 6(5 Pt 1): 10041011.
8.	Ikegami T, Masuda Y, Ohno Y, et al. Prognosis of adult patients transplanted with liver grafts < 35%of their standard liver volume [J]. Liver Transpl, 2009, 15(11): 16221630.
9.	Hill MJ, Hughes M, Jie T, et al. Graft weight/recipient weight ratio: how well does it predict outcome after partial liver transplants? [J]. Liver Transpl, 2009, 15(9): 10561062.
10.	王学浩, 李国强. 活体肝移植供体的安全性 [J]. 中华肝胆外科杂志, 2007, 13(2): 7577．.
11.	Kelly DM, Zhu X, Shiba H, et al. Adenosine restores the hepatic artery buffer response and improves survival in a porcine model of smallforsize syndrome [J]. Liver Transpl, 2009, 15(11): 14481457.
12.	Troisi R, Cammu G, Militerno G, et al. Modulation of portal graft inflow: a necessity in adult livingdonor liver transplantation? [J]. Ann Surg, 2003, 237(3): 429436.
13.	Chan SC, Lo CM, Ng KK, et al. Portal inflow and pressure changes in right liver living donor liver transplantation including the middle hepatic vein [J]. Liver Transpl, 2011, 17(2): 115121.
14.	Kamei H, Fujimoto Y, Nagai S, et al. Impact of noncongestive graft size in living donor liver transplantation: new indicator for additional vein reconstruction in right liver graft [J]. Liver Transpl, 2007, 13(9): 12951301.
15.	Brown RS Jr, Russo MW, Lai M, et al. A survey of liver transplantation from living adult donors in the United States [J]. N Engl J Med, 2003, 348(9): 818825.
16.	Kooby DA, Fong Y, Suriawinata A, et al. Impact of steatosis on perioperative outcome following hepatic resection [J]. J Gastrointest Surg, 2003, 7(8): 10341044.
17.	Vetelinen R, van Vliet AK, van Gulik TM. Severe steatosis increases hepatocellular injury and impairs liver regeneration in a rat model of partial hepatectomy [J]. Ann Surg, 2007, 245(1): 4450.
18.	BenHaim M, Emre S, Fishbein TM, et al. Critical graft size in adulttoadult living donor liver transplantation: impact of the recipient’s disease [J]. Liver Transpl, 2001, 7(11): 948953.
19.	Andorno E, Genzone A, Morelli N, et al. Marginal liver: case report of a successful OLT from an 84yearold donor [J]. Transplant Proc, 2001, 33(12): 1477.
20.	Katsuragawa H, Yamamoto M, Katagiri S, et al. Graft size and donor age are independent factors for graft loss in adulttoadult livingdonor liver transplantation using the left liver [J]. J Hepatobiliary Pancreat Surg, 2009, 16(2): 178183.
21.	Heaton ND, Rela M. Auxiliary liver transplantation//Maddrey WC, Schiff ER. Transplantation of the Liver [M]. Philadelphia: Lippincott Willians and Wilkins, 2001: 121.
22.	Vetelinen R, Bennink RJ, van Vliet AK, et al. Mild steatosis impairs functional recovery after liver resection in an experimental model [J]. Br J Surg, 2007, 94(8): 10021008.
23.	Hayashi M, Fujii K, Kiuchi T, et al. Effects of fatty infiltration of the graft on the outcome of livingrelated liver transplantation [J]. Transplant Proc, 1999, 31(12): 403.
24.	Rinella ME, Alonso E, Rao S, et al. Body mass index as a predictor of hepatic steatosis in living liver donors [J]. Liver Transpl, 2001, 7(5): 409414.
25.	Goddard CJ, Warnes TW. Raised liver enzymes in asymptomatic patients: investigation and outcome [J]. Dig Dis, 1992, 10(4): 218226.
26.	Selzner M, Kashfi A, Cattral MS, et al. A graft to body weight ratio less than 0.8 does not exclude adulttoadult rightlobe living donor liver transplantation [J]. Liver Transpl, 2009, 15(12): 17761782.
27.	Ibrahim S, Chen CL, Wang CC, et al. Small remnant liver volume after right lobe living donor hepatectomy [J]. Surgery, 2006, 140(5): 749755.
28.	Shi ZR, Yan LN, Li B, et al. Evaluation of standard liver volume formulae for chinese adults [J]. World J Gastroenterol, 2009, 15(32): 40624066.
29.	严律南. 活体肝移植的现状与展望 [J]. 中国普外基础与临床杂志, 2007, 14(2): 128131．.
30.	刘现忠, 王轩. 边缘性供肝对肝移植术后肝功能影响及对策 [J]. 中国普通外科杂志, 2010, 19(7): 809812．.
31.	廖海华, 朱晓峰, 何晓顺, 等. 肝移植中边缘供体使用经验的初步探讨 [J]. 中国普通外科杂志, 2009, 18(1): 48．.
32.	Ogura Y, Hori T, El Moghazy WM, et al. Portal pressure <15 mm Hg is a key for successful adult living donor liver transplantation utilizing smaller grafts than before [J] . Liver Transpl, 2010, 16(6): 718728.
33.	Gruttadauria S, Pagano D, Luca A, et al. Smallforsize syndrome in adulttoadult livingrelated liver transplantation [J]. World J Gastroenterol, 2010, 16(40): 50115015.
34.	叶启发, 佘兴国, 明英姿, 等. 脾切除对肝移植预后影响的回顾性探讨 [J]. 中国普外基础与临床杂志, 2008, 15(3): 159161．.
35.	Okamura S, Sakai T, Yoshikai H, et al. Case of overwhelming postsplenectomy infection(OPSI)with chronic hepatitis type C during peginterferon/ribavirin combination therapy [J]. Nippon Shokakibyo Gakkai Zasshi, 2009, 106(3): 411417.
36.	吴刚, 孙会东, 杨蕾, 等. 脾切除在防治小肝综合征中的作用 [J]. 中国医科大学学报, 2010, 39(2): 108111．.
37.	Yoshizumi T, Taketomi A, Soejima Y, et al. The beneficial role of simultaneous splenectomy in living donor liver transplantation in patients with smallforsize graft [J]. Transpl Int, 2008, 21(9): 833842.
38.	Sibulesky L, Nguyen JH, PazFumagalli R, et al. Treatment modalities for hypersplenism in liver transplant recipients with recurrent hepatitis C [J]. World J Gastroenterol, 2009, 15(40): 50105013.
39.	马立辉, 周健, 史丽民, 等. 脾动脉栓塞术对肝癌伴脾亢患者免疫功能的影响 [J]. 世界华人消化杂志, 2010, 18(7): 669675.
40.	Takada Y, Ueda M, Ishikawa Y, et al. Endtoside portocaval shunting for a smallforsize graft in living donor liver transplantation [J]. Liver Transpl, 2004, 10(6): 807810.
41.	Wu H, Yan LN, Li B, et al. Hepatic venous outflow reconstruction in right lobe graft without middle hepatic vein [J]. Hepatol Res, 2007, 37(12): 10441051.
42.	陈实, 彭承宏. 小肝综合症的研究进展 [J]. 中华器官移植杂志, 2009, 30(10): 638640．.
43.	Man K, Zhao Y, Xu A, et al. Fatderived hormone adiponectin combined with FTY 720 significantly improves smallforsize fatty liver graft survival [J]. Am J Transplant, 2006, 6(3): 467476.
44.	Inderbitzin D, Beldi G, Sidler D, et al. Granulocyte colonystimulating factor supports liver regeneration in a smallforsize liver remnant mouse model [J]. J Gastrointest Surg, 2007, 11(3): 280285.
45.	Ozden I, Kara M, Pinarbasi B, et al. Somatostatin and propranolol to treat smallforsize syndrome that occurred despite splenic artery ligation [J]. Exp Clin Transplant, 2007, 5(2): 686689.
46.	Humar A, Beissel J, Crotteau S, et al. Delayed splenic artery occlusion for treatment of established smallforsize syndrome after partial liver transplantation [J]. Liver Transpl, 2009, 15(2): 163168.

1. Hashikura Y, Makuuchi M, Kawasaki S, et al. Successful livingrelated partial liver transplantation to an adult patient [J]. Lancet, 1994, 343(8907): 12331234.
2. Kiuchi T, Kasahara M, Uryuhara K, et al. Impact of graft size mismatching on graft prognosis in liver transplantation from living donors [J]. Transplantation, 1999, 67(2): 321327.
3. Dahm F, Georgiev P, Clavien PA. Smallforsize syndrome after partial liver transplantation: definition, mechanisms of disease and clinical implications [J]. Am J Transplant, 2005, 5(11): 26052610.
4. Sanefuji K, Iguchi T, Ueda S, et al. New prediction factors of smallforsize syndrome in living donor adult liver transplantation for chronic liver disease [J]. Transpl Int, 2010, 23(4): 350357.
5. Imura S, Shimada M, Ikegami T, et al. Strategies for improving the outcomes of smallforsize grafts in adulttoadult livingdonor liver transplantation [J]. J Hepatobiliary Pancreat Surg, 2008, 15(2): 102110.
6. Lo CM, Fan ST, Liu CL, et al. Minimum graft size for successful living donor liver transplantation [J]. Transplantation, 1999, 68(8): 11121116.
7. Soejima Y, Taketomi A, Yoshizumi T, et al. Feasibility of left lobe living donor liver transplantation between adults: an 8year,singlecenter experience of 107 cases [J]. Am J Transplant, 2006, 6(5 Pt 1): 10041011.
8. Ikegami T, Masuda Y, Ohno Y, et al. Prognosis of adult patients transplanted with liver grafts < 35%of their standard liver volume [J]. Liver Transpl, 2009, 15(11): 16221630.
9. Hill MJ, Hughes M, Jie T, et al. Graft weight/recipient weight ratio: how well does it predict outcome after partial liver transplants? [J]. Liver Transpl, 2009, 15(9): 10561062.
10. 王学浩, 李国强. 活体肝移植供体的安全性 [J]. 中华肝胆外科杂志, 2007, 13(2): 7577．.
11. Kelly DM, Zhu X, Shiba H, et al. Adenosine restores the hepatic artery buffer response and improves survival in a porcine model of smallforsize syndrome [J]. Liver Transpl, 2009, 15(11): 14481457.
12. Troisi R, Cammu G, Militerno G, et al. Modulation of portal graft inflow: a necessity in adult livingdonor liver transplantation? [J]. Ann Surg, 2003, 237(3): 429436.
13. Chan SC, Lo CM, Ng KK, et al. Portal inflow and pressure changes in right liver living donor liver transplantation including the middle hepatic vein [J]. Liver Transpl, 2011, 17(2): 115121.
14. Kamei H, Fujimoto Y, Nagai S, et al. Impact of noncongestive graft size in living donor liver transplantation: new indicator for additional vein reconstruction in right liver graft [J]. Liver Transpl, 2007, 13(9): 12951301.
15. Brown RS Jr, Russo MW, Lai M, et al. A survey of liver transplantation from living adult donors in the United States [J]. N Engl J Med, 2003, 348(9): 818825.
16. Kooby DA, Fong Y, Suriawinata A, et al. Impact of steatosis on perioperative outcome following hepatic resection [J]. J Gastrointest Surg, 2003, 7(8): 10341044.
17. Vetelinen R, van Vliet AK, van Gulik TM. Severe steatosis increases hepatocellular injury and impairs liver regeneration in a rat model of partial hepatectomy [J]. Ann Surg, 2007, 245(1): 4450.
18. BenHaim M, Emre S, Fishbein TM, et al. Critical graft size in adulttoadult living donor liver transplantation: impact of the recipient’s disease [J]. Liver Transpl, 2001, 7(11): 948953.
19. Andorno E, Genzone A, Morelli N, et al. Marginal liver: case report of a successful OLT from an 84yearold donor [J]. Transplant Proc, 2001, 33(12): 1477.
20. Katsuragawa H, Yamamoto M, Katagiri S, et al. Graft size and donor age are independent factors for graft loss in adulttoadult livingdonor liver transplantation using the left liver [J]. J Hepatobiliary Pancreat Surg, 2009, 16(2): 178183.
21. Heaton ND, Rela M. Auxiliary liver transplantation//Maddrey WC, Schiff ER. Transplantation of the Liver [M]. Philadelphia: Lippincott Willians and Wilkins, 2001: 121.
22. Vetelinen R, Bennink RJ, van Vliet AK, et al. Mild steatosis impairs functional recovery after liver resection in an experimental model [J]. Br J Surg, 2007, 94(8): 10021008.
23. Hayashi M, Fujii K, Kiuchi T, et al. Effects of fatty infiltration of the graft on the outcome of livingrelated liver transplantation [J]. Transplant Proc, 1999, 31(12): 403.
24. Rinella ME, Alonso E, Rao S, et al. Body mass index as a predictor of hepatic steatosis in living liver donors [J]. Liver Transpl, 2001, 7(5): 409414.
25. Goddard CJ, Warnes TW. Raised liver enzymes in asymptomatic patients: investigation and outcome [J]. Dig Dis, 1992, 10(4): 218226.
26. Selzner M, Kashfi A, Cattral MS, et al. A graft to body weight ratio less than 0.8 does not exclude adulttoadult rightlobe living donor liver transplantation [J]. Liver Transpl, 2009, 15(12): 17761782.
27. Ibrahim S, Chen CL, Wang CC, et al. Small remnant liver volume after right lobe living donor hepatectomy [J]. Surgery, 2006, 140(5): 749755.
28. Shi ZR, Yan LN, Li B, et al. Evaluation of standard liver volume formulae for chinese adults [J]. World J Gastroenterol, 2009, 15(32): 40624066.
29. 严律南. 活体肝移植的现状与展望 [J]. 中国普外基础与临床杂志, 2007, 14(2): 128131．.
30. 刘现忠, 王轩. 边缘性供肝对肝移植术后肝功能影响及对策 [J]. 中国普通外科杂志, 2010, 19(7): 809812．.
31. 廖海华, 朱晓峰, 何晓顺, 等. 肝移植中边缘供体使用经验的初步探讨 [J]. 中国普通外科杂志, 2009, 18(1): 48．.
32. Ogura Y, Hori T, El Moghazy WM, et al. Portal pressure <15 mm Hg is a key for successful adult living donor liver transplantation utilizing smaller grafts than before [J] . Liver Transpl, 2010, 16(6): 718728.
33. Gruttadauria S, Pagano D, Luca A, et al. Smallforsize syndrome in adulttoadult livingrelated liver transplantation [J]. World J Gastroenterol, 2010, 16(40): 50115015.
34. 叶启发, 佘兴国, 明英姿, 等. 脾切除对肝移植预后影响的回顾性探讨 [J]. 中国普外基础与临床杂志, 2008, 15(3): 159161．.
35. Okamura S, Sakai T, Yoshikai H, et al. Case of overwhelming postsplenectomy infection(OPSI)with chronic hepatitis type C during peginterferon/ribavirin combination therapy [J]. Nippon Shokakibyo Gakkai Zasshi, 2009, 106(3): 411417.
36. 吴刚, 孙会东, 杨蕾, 等. 脾切除在防治小肝综合征中的作用 [J]. 中国医科大学学报, 2010, 39(2): 108111．.
37. Yoshizumi T, Taketomi A, Soejima Y, et al. The beneficial role of simultaneous splenectomy in living donor liver transplantation in patients with smallforsize graft [J]. Transpl Int, 2008, 21(9): 833842.
38. Sibulesky L, Nguyen JH, PazFumagalli R, et al. Treatment modalities for hypersplenism in liver transplant recipients with recurrent hepatitis C [J]. World J Gastroenterol, 2009, 15(40): 50105013.
39. 马立辉, 周健, 史丽民, 等. 脾动脉栓塞术对肝癌伴脾亢患者免疫功能的影响 [J]. 世界华人消化杂志, 2010, 18(7): 669675.
40. Takada Y, Ueda M, Ishikawa Y, et al. Endtoside portocaval shunting for a smallforsize graft in living donor liver transplantation [J]. Liver Transpl, 2004, 10(6): 807810.
41. Wu H, Yan LN, Li B, et al. Hepatic venous outflow reconstruction in right lobe graft without middle hepatic vein [J]. Hepatol Res, 2007, 37(12): 10441051.
42. 陈实, 彭承宏. 小肝综合症的研究进展 [J]. 中华器官移植杂志, 2009, 30(10): 638640．.
43. Man K, Zhao Y, Xu A, et al. Fatderived hormone adiponectin combined with FTY 720 significantly improves smallforsize fatty liver graft survival [J]. Am J Transplant, 2006, 6(3): 467476.
44. Inderbitzin D, Beldi G, Sidler D, et al. Granulocyte colonystimulating factor supports liver regeneration in a smallforsize liver remnant mouse model [J]. J Gastrointest Surg, 2007, 11(3): 280285.
45. Ozden I, Kara M, Pinarbasi B, et al. Somatostatin and propranolol to treat smallforsize syndrome that occurred despite splenic artery ligation [J]. Exp Clin Transplant, 2007, 5(2): 686689.
46. Humar A, Beissel J, Crotteau S, et al. Delayed splenic artery occlusion for treatment of established smallforsize syndrome after partial liver transplantation [J]. Liver Transpl, 2009, 15(2): 163168.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Advances in Small-for-Size Syndrome in Living Donor Liver Transplantation

Abstract Full text Figures/Tables Video References Cited by

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