الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
L
iving donor liver transplantation (LDLT) is the only treatment for patients with End stage Liver diseases and Liver tumors in Egypt, although In living donor liver transplantation (LDLT) there are two paradoxical concerns of adult LDLT. One is the size of liver remnant for the donor, and another is minimum graft size for the recipient, in considering living donor safety and recipients’ prognosis.
The graft volume and graft to recipient weight ratio (GRWR) is an important selection criterion for living donor liver transplantation (LDLT). The generally accepted threshold is known to be ≥ 0.8% to meet the metabolic demand of the recipient.
Small-for-size graft (SFSG) is the graft with GRWR < 0.8 and when its unable to meet the recipients metabolic demands, small-for-size syndrome (SFSS) occurs which is clinically characterized by a postoperative prolonged hyperbilirubinemia, presence of severe ascites, prolonged coagulopathy, and encephalopathy, which would result in poor postoperative outcomes. In fact, there was evidence showing that SFSG resulted in significantly worse graft survival, but according to our study by portal flow modulation by administration of glypressin with or without splenectomy decreased post operative SFSS manifestations and consequently post operative hyperbilirubinemia and ascites in most of cases with SFSS, while there was statistically significant difference in increase of INR value >2 during 1sr week post transplantation and encephalopathy even with portal flow modulation in most of the cases diagnosed as SFSS.
Our study retrospectively analysed the difference between preoperative estimated graft volume by CT volumetry and actual graft volume intraoperative to detect the discrepancy in volume difference and consequently GRWR difference and lower GRWR and the volume difference was (126.37 g) with p value (0.000) with nearly 13.7% discrepancy was demonstrated as an overestimation of the graft volume which was an important factor in our study that lead to SFSS.
We found that the difference in graft volume and consequently in GRWR between preoperative estimated graft volume and actual graft volume increasing with age.
We found that there was a significant statistical difference between recipients with SFSS and those without in regard to recipient’s BMI and Decreasing BMI of the recipient play a role in decreasing the incidence of SFSS and its manifestations.
CONCLUSION
P
roper preoperative evaluation of the donor graft volume should be performed in order to prevent donor morbidity and mortality, as well as small-for-size syndrom in the recipient. Physicians working in the field of transplantation should be aware of the fact that a difference of 13.7 % between the predicted and the actual graft volume is usually encountered.
And if SFSS encountered glypressin with or without splenectomy has an important role in portal flow modulation to decrease SFSS manifestaions and better graft survival on basis to our study.
And that Age had a significant impact on the discrepancy between the predicted and actual graft volume, while gender and BMI did not.
Decreasing BMI of the recipient play a role in decreasing the incidence of SFSS and its manifestations.