The model for end-stage liver disease (MELD) system is a good tool to predict short-term mortality among living donor liver transplantation (AALDLT) recipients and has also been suggested to prohibited live liver donation for recipients with MELD scores[25 [1]. A partial liver graft transplanted into an adult recipient is often defined as a small-for-size graft. It is generally accepted that such graft would be tolerated when the graft-to-body weight ratio (GBWR) is higher than 0.8. However, transplanted liver will suffer small-for-size syndrome (SFSS) and irreversible damage when GBWR \0.8. In AALDLT, graft size and pre-transplant MELD scores are important factors for patient post-transplant survival [2]. Here we evaluated the outcome of using a SFSG in AALDLT recipients with different MELD scores in a single liver transplant center. Clinical data of 118 patients who had right-lobe AALDLT from January 2004 to December 2011 were retrospectively analyzed. According to MELD, patients were divided into group L (MELD score B25, n = 102) and group H (MELD score [25, n = 16). To analyze the risk of the graft size, the patients were further stratified into group LS (MELD score B25, GBWR\0.8, n = 23), group LN (MELD score B25, GBWR C0.8, n = 79), group HS (MELD score [25, GBWR \0.8, n = 5), and group HN (MELD score [25, GBWR C0.8, n = 11). MELD scores between the two groups were significantly different. There was no significant difference in preoperative demographic data as well as postoperative liver function data. The length of ICU and hospital stay, graft loss, and mortality were similar in both groups. Complication rate was also similar between two groups (10.8 vs 6.3 %, P = 1.000). The 1and 3-year survival rate were similar between group L and group H (85.2 vs 74 %, 78.9 vs 74 %, P = 0.692). After stratified into groups LS, LN, HS, and HN, there were no significant differences among groups in 1and 3-year survival rate. Multivariate analysis revealed that accompanied hepatocellular carcinoma (HCC), GBWR, and MELD scores did not predict the 1and 3-year survival rate. Recipients with high MELD scores usually have worse preoperative conditions and experience a more complicated peri-operative course. However, there are still debates on this subject. Hayashi et al. [3] reported that there was no correlation between the 1-year survival rate and MELD scores. According to Yi et al. [4], the 1-year survival rate without HCC was found to be similar between those two groups as well as the rate of postoperative complications. In our report, the postoperative complication rate, ICU and hospital stay length after AALDLT did not differ between recipients. Pneumonia was still the first cause of death. We attributed these advanced results to a high level of perioperative intensive care for high MELD score recipients. When using a graft with GBWR less than 0.8 in AALDLT, recipients possibly suffer postoperative irreversible liver damage. However, Yi et al. [4] also reported that a high MELD score ([25) was not an important predictor of the 1-year survival rate in cases with an SFSG. Reconstruction of the MHV is well known as an important factor to reduce the incidence of graft failure in an SFSG. In our study, although there was no significant difference in survival rates among groups with versus without MHV, we might H. Li B. Li (&) Department of Liver and Vascular Surgery, Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China e-mail: doclibo@126.com