Preventing Small-for-size Syndrome in Living Donor Liver Transplantation: Guidelines From the ILTS-iLDLT-LTSI...

Area of Science:

• Hepatology
• Transplantation Surgery
• Gastroenterology

Background:

• Small-for-size syndrome (SFSS) is a significant complication in liver transplantation (LT), particularly affecting living donor LT (LDLT) recipients.
• SFSS occurs in up to 20% of LDLT cases, highlighting the need for effective prevention strategies.

Purpose of the Study:

• To develop evidence-based recommendations for the prediction and management of SFSS in LDLT.
• To provide practical guidelines for preventing SFSS in living donor liver transplantation.

Main Methods:

• A consensus conference involving international experts was convened in January 2023.
• Recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.
• Four working groups focused on diagnosis, prevention, anesthesia/critical care, and management of established SFSS.

Main Results:

• The report presents final statements and recommendations from working group 2, focusing on SFSS prevention in LDLT.
• Key preventive strategies involve meticulous donor and recipient selection, adequate outflow reconstruction, graft portal inflow modulation, and management of portosystemic shunts.

Conclusions:

• Implementing these evidence-based recommendations can significantly reduce the incidence of SFSS in LDLT.
• Proactive management and adherence to consensus guidelines are crucial for successful LDLT outcomes.