Abstract
We report the case of a 17-year-old male who underwent living-donor liver transplantation for liver cirrhosis of unknown origin (left-lobe graft, graft-to-recipient weight ratio: GRWR 1.05). After transplantation, he developed prolonged cholestasis, refractory ascites and pancytopenia, requiring daily blood transfusion. Liver biopsy examination on postoperative day (POD) 7 showed cholestasis and centrilobular necrosis. Doppler ultrasound examination showed a decrease in hepatic artery velocity and an increase in pulsatility index. A condition similar to small-for-size syndrome (SFSS) was suspected, and proximal splenic artery embolization was performed on POD 37, resulting in a marked improvement of hepatic artery hemodynamics. His liver function gradually normalized and he was discharged on POD 93. SFSS is considered as the condition wherein the graft volume is insufficient to sustain metabolic demands in the recipient. Portal hyperperfusion contributes to the clinical and histopathological manifestations of SFSS. Some surgical strategies for portal flow modulation to prevent SFSS for high-risk cases, such as splenectomy and splenic artery ligation, can be performed. In the current case, the graft size was sufficient, and we were unable to predict the development of SFSS. We performed angiography and proximal splenic artery embolization for therapeutic diagnosis and his condition was improved by a less invasive procedure.
