LAUSR

R ecently, the piggyback method of liver transplantation became increasingly used. This technique consists of removing the diseased liver with preservation of the retrohepatic portion of the inferior vena cava (IVC). In this method, reconstitution of the venous drainage path is performed by means of an anastomosis between the suprahepatic portion of donor’s IVC and the ostium of the recipient’s hepatic veins. On comparing with the conventional method, piggyback transplantation allowed greater hemodynamic stability, lower consumption of blood components, shorter warm ischemia time, and lower hospital charges. In contrast to these advantages, there are some inconveniences such as a specific difficulty in venous drainage of the liver. Moreover, suboptimal donor livers such as small-for-size grafts are sometimes unavoidably used for transplantation given the limited number of donors. The use of a small-for-size graft provides only a limited required liver volume to an adult recipient, which is insufficient to sustain their metabolic demands, leading to small-for-size syndrome (SFSS). The transient portal hypertension and microcirculatory hemodynamic derangement in the initial first week after reperfusion are the critical events in the pathogenesis of small-for-size graft, which significantly decrease the rate of liver regeneration. Apart from the increased inflow and hyperperfusion