Published online Jul 28, 2017. doi: 10.4254/wjh.v9.i21.930
Peer-review started: December 19, 2016
First decision: March 28, 2017
Revised: April 14, 2017
Accepted: June 19, 2017
Article in press: June 20, 2017
Published online: July 28, 2017
Core tip: Small for size syndrome (SFSS) was diagnosed in 20 (11.5%) of our recipients where, small for size dysfunction affected 16 of patients (80%) and small for size non function was present in four patients (20%). Regarding graft size in patients with SFSS; 10, 5 and 5 of patients had extra-small graft [small for size graft (SFSG), graft recipient weight ratio (GRWR) < 0.8], small graft (GRWR ≥ 0.8 and < 1) and medium sized graft (GRWR ≥ 1) respectively. Extra small graft (SFSG), portal hyper-perfusion, severe portal hypertension (PHTN), and venous outflow obstruction were the main direct causes of SFSS in 10 (50%), 3 (15%), 4 (20%), and 3 (15%) of patients respectively. While extra-small graft, PHTN, steatosis and left lobe graft were significant predictors of SFSS in univariate analysis, only graft size was independent predictor of SFSS on multivariate analysis. On the other hand, there was non-significant lower incidence of SFSS in patients with SFSG when splenectomy was done, furthermore, there was non-significant lower incidence of the syndrome in patients with right lobe graft when drainage of the right anterior and/or posterior liver sectors by middle hepatic vein, V5, V8, and/or right inferior vein was done. The SFSS related mortalities were recorded in 13/20 of patients (65%). The 6-mo, 1-, 3-, 5-, 7- and 10-year survival in patients with SFSS were 30%, 30%, 25%, 25%, 25% and 25% respectively, while, the 6-mo, 1-, 3-, 5-, 7- and 10-year survival in patients without SFSS were 70.1%, 65.6%, 61.7%, 61%, 59.7%, and 59.7% respectively, with statistical significant difference.