Small for Size Syndrome in Adult-to-Adult Living Donor Liver Transplantation: A Review of the Latest Literature

Living donor liver transplantation (LDLT) has emerged as a popular solution to address the organ shortage, driven by ethical considerations and its increasing demand over the last decade. Nonetheless, in the contest of this innovative technique the emergence of small-for-size syndrome (SFSS) poses a significant challenge, stemming from inadequate liver remnant size to meet postoperative metabolic demands. This can significantly impact the outcomes for both donors and recipients of LDLT. Addressing this challenge necessitates a comprehensive evaluation of the donor, graft, and recipient. Our systematic review, conducted in adherence to PRISMA guidelines, identified 15 articles meeting eligibility criteria. SFSS manifests post-liver transplantation when the transplanted liver fails to meet the recipient’s metabolic needs during the recovery phase from end-stage liver disease. Clinical signs, laboratory findings, and Doppler assessments are necessary for diagnosis to facilitate timely interventions and prevent irreversible graft damage. Preventive strategies encompass meticulous donor-recipient selection, precise surgical techniques, and diligent postoperative care. These findings underscore the imperative for ongoing research and the formulation of effective preventive measures to optimize the success of LDLT and enhance patient outcomes.