Shoreem H, Gad EH, Soliman H, Hegazy O, Saleh S, Zakaria H, Ayoub E, Kamel Y, Abouelella K, Ibrahim T, Marawan I. Small for size syndrome difficult dilemma: Lessons from 10 years single centre experience in living donor liver transplantation. World J Hepatol 2017; 9(21): 930-944 [PMID: 28824744 DOI: 10.4254/wjh.v9.i21.930]
Corresponding Author of This Article
Emad Hamdy Gad, MD, Lecturer of Hepatobiliary and Liver Transplantation Surgery, Hepatobiliary Surgery Department, National Liver Institute, Menoufiya University, 77 Algala albahary Street, Mansour Building, Shibin El-Koum 32817, Egypt. emad.gad1@liver.menofia.edu.eg
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hany Shoreem, Emad Hamdy Gad, Hosam Soliman, Osama Hegazy, Sherif Saleh, Hazem Zakaria, Eslam Ayoub, Kalid Abouelella, Tarek Ibrahim, Ibrahim Marawan, Hepatobiliary Surgery Department, National Liver Institute, Menoufiya University, Shibin El-Koum 32817, Egypt
Yasmin Kamel, Anesthesia Department, National Liver Institute, Menoufiya University, Shibin El-Koum 32817, Egypt
Author contributions: Forms of support received by each author for this study included good selection of cases, instructive supervision, continuous guidance, valuable suggestions and good instructions. Furthermore, the authors of the manuscript shared in its data collection, writing, and publication; moreover, the corresponding author did statistical analysis as well.
Institutional review board statement: The study was reviewed and approved for publication by our institutional reviewers.
Informed consent statement: The data were collected from our records in the LT unit and written informed consents were obtained from both donors and recipients regarding operations and researches.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The technical appendix and original anonymous dataset is available on request from the corresponding author at emadgadsalemaa@yahoo.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Emad Hamdy Gad, MD, Lecturer of Hepatobiliary and Liver Transplantation Surgery, Hepatobiliary Surgery Department, National Liver Institute, Menoufiya University, 77 Algala albahary Street, Mansour Building, Shibin El-Koum 32817, Egypt. emad.gad1@liver.menofia.edu.eg
Telephone: +20-100-3031128 Fax: +20-48-2234685
Received: December 15, 2016 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 Processing time: 222 Days and 5.2 Hours
Core Tip
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.
