Journal article
Management of Established Small-for-size Syndrome in Post Living Donor Liver Transplantation: Medical, Radiological, and Surgical Interventions: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference
Transplantation, Vol.107(10), pp.2238-2246
10/2023
DOI: 10.1097/TP.0000000000004771
PMID: 37749813
Abstract
Small-for-size syndrome (SFSS) following living donor liver transplantation is a complication that can lead to devastating outcomes such as prolonged poor graft function and possibly graft loss. Because of the concern about the syndrome, some transplants of mismatched grafts may not be performed. Portal hyperperfusion of a small graft and hyperdynamic splanchnic circulation are recognized as main pathogenic factors for the syndrome. Management of established SFSS is guided by the severity of the presentation with the initial focus on pharmacological therapy to modulate portal flow and provide supportive care to the patient with the goal of facilitating graft regeneration and recovery. When medical management fails or condition progresses with impending dysfunction or even liver failure, interventional radiology (IR) and/or surgical interventions to reduce portal overperfusion should be considered. Although most patients have good outcomes with medical, IR, and/or surgical management that allow graft regeneration, the risk of graft loss increases dramatically in the setting of bilirubin >10 mg/dL and INR>1.6 on postoperative day 7 or isolated bilirubin >20 mg/dL on postoperative day 14. Retransplantation should be considered based on the overall clinical situation and the above postoperative laboratory parameters. The following recommendations focus on medical and IR/surgical management of SFSS as well as considerations and timing of retransplantation when other therapies fail.
Details
- Title: Subtitle
- Management of Established Small-for-size Syndrome in Post Living Donor Liver Transplantation: Medical, Radiological, and Surgical Interventions: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference
- Creators
- Varvara A. Kirchner - Stanford UniversitySadhana Shankar - King's College HospitalDavid W. Victor - Houston MethodistTomohiro Tanaka - University of IowaNicolas Goldaracena - University of Virginia Health SystemRoberto I. Troisi - Federico II University HospitalKim M. Olthoff - Hospital of the University of PennsylvaniaJong Man Kim - Samsung Medical CenterElizabeth A. Pomfret - Children's Hospital ColoradoNigel Heaton - King's College HospitalWojtek G. Polak - The Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the NetherlandsAkash Shukla - King Edward Memorial Hospital and Seth G.S. Medical CollegeRavi Mohanka - Global HospitalsDeniz Balci - Bahçeşehir UniversityMark Ghobrial - Houston MethodistSubash Gupta - Max HealthcareDaniel Maluf - University of Maryland Medical CenterJohn J. Fung - University of ChicagoSusumu Eguchi - Nagasaki UniversityJohn Roberts - University of California San Francisco Medical CenterBijan Eghtesad - Cleveland Clinic Lerner College of MedicineMarkus Selzner - University Health NetworkRaj Prasad - Medical College of WisconsinMureo Kasahara - National Center For Child Health and DevelopmentHiroto Egawa - Tokyo Women's Medical UniversityJan Lerut - UCLouvainDieter Broering - King Faisal Specialist Hospital & Research CentreMarina Berenguer - Instituto de Investigación Sanitaria La FeMark S. Cattral - University Health NetworkPierre-Alain Clavien - University Hospital of ZurichChao-Long Chen - Chang Gung UniversitySamir R. Shah - Global HospitalsZhi-Jun ZhuNancy Ascher - University of California San Francisco Medical CenterToru Ikegami - Jikei University School of MedicinePrashant Bhangui - Medanta The MedicityAshwin Rammohan - The Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chennai, IndiaJean C. Emond - Columbia UniversityMohamed Rela - The Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chennai, India
- Resource Type
- Journal article
- Publication Details
- Transplantation, Vol.107(10), pp.2238-2246
- DOI
- 10.1097/TP.0000000000004771
- PMID
- 37749813
- ISSN
- 0041-1337
- eISSN
- 1534-6080
- Language
- English
- Date published
- 10/2023
- Academic Unit
- Gastroenterology and Hepatology; Internal Medicine
- Record Identifier
- 9984472530802771
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