Small for size syndrome difficult dilemma: Lessons from 10 years single centre experience in living donor liver transplantation

Figure 1 Graft with V5 to be anastomosed with recipient liver transplantation hepatic vein. A: Computed tomography venography showing large V5; B: A jumping graft between the V5 vein of liver graft and liver transplantation hepatic vein of recipient.

Figure 2 Graft with V8 to be anastomosed with recipient inferior vena cava by jumping graft. A: Obtaining the venous graft from native PV; B: The venous graft; C: V8 vein during back table preparation; D and E: Anastomosing the venous graft to V8; F: Preparation for anastomosing the venous graft to IVC. IVC: Inferior vena cava.

Figure 3 Venous graft obtained from native PUV, portal venous and hepatic vein to communicate 2 V5, 1V8 and right hepatic vein of liver graft with recipient inferior vena cava.

Figure 4 Small right hepatic vein (encircled) and large right inferior vein harvested and anastomosed with recipient inferior vena cava.

Figure 5 Kaplan-Meier survival curves (1, 2, 3). A: KM survival curve; B: SFSG and survival [SFSG (GRWR < 0.8) = 2, Log-Rank = 0.00]; C: SFSS and survival (SFSS = 1, Log-Rank = 0.00); D: KM graft survival curve; E: SFSS and graft survival (SFSS = 1, Log-Rank = 0.00). SFSG: Small for size graft; GRWR: Graft recipient weight ratio; SFSS: Small for size syndrome.