Small for Size Syndrome: How Small is Actually Too Small?

Kiuchi first described Small-for-size syndrome (SFSS) in recipients of small sized liver grafts with graft to recepient weight ratio (GRWR) of < 1.0% and graft volume to standard liver volume of < 35%. SFSS was initially described as a spectrum of clinical manifestations resulting from the use of smaller sized liver grafts. This is more common with living donor liver transplantation (LDLT), but also has been reported with deceased donor liver transplantation (DDLT). Graft size is the only independent predictor of SFSS, however SFSS can occur even in the presence of a normal GRWR.