Abstract
Pathogenic aspects of the small-for-size graft failuresyndrome consist of portal hyperperfusion and insuffi-cient venous outflow leading to arterial hypoperfusionwith reduced liver function and reduced capacity forregeneration. Histologically, small-for-size graft failuresyndrome is characterized by sinusoidal congestionand mitochondrial swelling with disruption of the sinu-soidal lining, resulting in impaired bile secretion andsevere cholestasis. Clinically, small-for-size graft fail-ure syndrome is characterized by severe cholestasis,ascites, and coagulopathy.Over time, many livers recover, but some do not.Early graft dysfunction predisposes recipients to sep-sis. Lee and colleagues reported a significantly de-creased survival rate in patients receiving grafts thathad a graft weight/recipient ratio 1% (80% survivalvs. 96%).
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