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Cited by 180Organ Transplantation Techniques and OutcomesLiver physiology and pathologyHepatocellular Carcinoma Treatment and Prognosis

The ???small for size??? liver syndrome

Tucker, O N, Heaton, N·2005·Current Opinion in Critical Care
DOI 10.1097/01.ccx.0000157080.11117.45
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Abstract

Purpose of review Small-for-size syndrome (SFSS) is a clinical syndrome described following liver transplantation (LT) and extended hepatectomy. New evidence has emerged documenting the importance of preoperative evaluation of functional liver mass, liver quality, influence of portal hypertension, and variations in surgical technique to improve outcome. Recent findings SFSS is characterized by postoperative coagulopathy and liver dysfunction due to insufficient functional liver mass. Recent radiologic advances allow accurate preoperative estimation of total, graft, and remnant liver volume (RLV). In adult-to-adult living donor liver transplantation (LDLT), a graft-to-recipient body weight ratio > or = 0.8% or graft weight ratio > or = 30% are important to avoid SFSS. Minimal functional RLV following extended hepatectomy is > or = 25% in a normal liver, and > or = 40% with preoperative liver dysfunction. Preoperative portal vein or hepatic artery embolization to increase RLV and function after extended hepatectomy, and the increasing use of parenchymal-sparing segmental resections have improved outcome. In LT, the evolving use of split livers, LDLT and marginal grafts has resulted in increased recognition of SFSS. This has led to a renewed interest in defining the pathophysiology, and the development of new surgical techniques to reduce its incidence. Summary Current radiologic imaging techniques can be used to evaluate liver volume and the risk of SFSS following LT and extend…

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Crossref · 10.1097/01.ccx.0000157080.11117.45

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  • SFSS is associated with a liver remnant or graft to body weight ratio <0.8% or a remnant to total liver volume of less than 25%-30%.

    “SFSS is associated with a liver remnant or graft to body weight ratio <0.8% or a remnant to total liver volume of less than 25%–30%, where the liver is too small to handle post-operative metabolic demands.157”

    From Distinct hepatocyte identities in liver homeostasis and regeneration (2023) · cites this paper as [157]

  • Insufficient functional hepatic mass following hepatic transplantation or after resection, termed SFSS, can be fatal.

    “In addition to loss of zonal hepatocyte identity and hepatocyte cell death associated with acute liver failure or chronic liver disease, insufficient functional hepatic mass either following hepatic transplantation or after resection, termed small-for-size syndrome (SFSS), can be fatal.”

    From Distinct hepatocyte identities in liver homeostasis and regeneration (2023) · cites this paper as [157]

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Authors
Tucker, O. N., & Heaton, N.
Affiliations
King's College Hospital (GB)
Corresponding author
Heaton, N
ORCID
Heaton, N
Venue
Current Opinion in Critical Care
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2005-04
Volume
11
Issue
2
Pages
150-155
ISSN
1070-5295 (ISSN-L)
DOI
10.1097/01.ccx.0000157080.11117.45
OpenAlex
W1985757414
Cited by
180
References
65
Citations by year
2025: 2 · 2024: 4 · 2023: 6 · 2022: 4 · 2021: 7 · 2020: 9 · 2019: 11 · 2018: 6 · 2017: 14 · 2016: 11 · 2015: 7 · 2014: 14 · 2013: 17 · 2012: 14
FWCI
1.62
Type
journal article
Language
en
Open access
closed
Locations
  • Current Opinion in Critical Care (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
  • Health Sciences › Medicine › Hepatology › Liver physiology and pathology
  • Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
Keywords
small-for-size syndrome, liver transplantation, extended hepatectomy, living donor liver transplantation, remnant liver volume, graft-to-recipient weight ratio, portal hypertension, preoperative embolization, split liver transplantation, marginal grafts, postoperative coagulopathy, liver regeneration
MeSH terms
Adult, Hepatectomy, Humans, Hypertension, Portal, Liver, Organ Size, Syndrome, Liver Transplantation, Hepatic Insufficiency

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