Small-for-size Syndrome

Small-for-size syndrome (SFSS) refers to donor organ size mismatch post-liver transplantation. At present, the minimal accepted graft volume is 0.8-1.0% (graft to whole body ratio). Smaller liver grafts frequently cause problems such as intrahepatic cholestasis and increased portal pressure. The current literature seems to suggest that this is caused by portal hypertension and hyperperfusion. Some studies have used surgical techniques such as portosystemic or portocaval shunting, splenectomy, ligation of the splenic artery, dual-graft transplantation and reconstruction of the hepatic veins to help reduce the incidence of SFSS. This article, based on current literature on SFSS, aims to present a definition, discuss potential pathogenic mechanisms and give an overview of strategies to improve or prevent its occurrence.