Risk Factors of SFSS in Adult-to-Adult Living Donor Liver Transplantation Using the Right Liver: A Single-Center Analysis of 217 Cases

Small-for-size Syndrome (SFSS) in adult-adult living right lobe liver transplantation (A-ALRLT) remains the greatest limiting factor for the expansion of using segmental liver transplantation and the major cause of worse short-term prognoses after LDLT. The causes of SFSS are not clear, so in this study we approached the risk factors of the SFSS.The study included 217 consecutive adult recipients that underwent living right lobe liver transplantation at our center. Cases were divided into two groups: 45 cases were determined as SFSS and 172 cases without SFSS within one month after transplantation. Preoperative factors like donor and recipient characteristics, operational data and postoperative factors were compared between the two groups. Factors possibly related to postoperative SFSS were also analyzed using logistic regression.After comparing the two groups, there was no significant difference in donor and recipient background characteristics and no differences were found between the two groups, except for portal inflow volume and MELD score which were much higher and GRWR and outflow volume were much lower in G1. Logistic regression analysis revealed four independent factors associated with SFSS development in right lobe graft: GRWR, MELD score, portal inflow volume and outflow capacity.Small GRWR, high MELD score, high portal inflow volume and low outflow capacity are four risk factors in A-ALRLT.