Journal of Liver

Small for size syndrome after extended Hepatectomy: New scenarios opened by flow theory. A case series and related therapy recommendations

World Congress on Hepatitis

July 20-22, 2015 Orlando, Florida, USA

Simone Famularo

Posters-Accepted Abstracts: J Liver

Abstract:

Background: Small-for-size syndrome is an acute liver failure which occurs in small-for-size grafts after living donor liver transplantations, and after major liver resections, usually assessed on or after the day 5 postop. Up to 35% of patients undergoing major hepatectomy can develop the syndrome. It consists in hyperbilirubinemia, coagulopathy, and increased portal vein pressure, due to an overflow in the portal microvascular bed respect to the liver remnant?s size. Case Reports: Three cases of patients who underwent major liver resections for liver metastasis are presented. All three developed small for size syndrome, with continuous improvement of bilirubin serum levels, and GGT. All the patients have been checked for portal vein wedge pressure, demonstrating hypertension in the portal vessel bed. To cure the syndrome, we report the use of treatments usually used in liver transplantation to avoid small-for-size-syndrome, such as Splenic Artery Embolization and Octreotide, focusing our approach on overflow and over-pressure, with different size remnants. Conclusion: Whilst literature is focused on prevention of SFSS in case of living donor liver transplantation, there is not enough evidence about how to treat patients who undergo extended hepatectomy. We report a completed rehabilitation of each case, suggesting a prevalent role of the blood flow and pressure parameters with different size remnants, according to the most recent evidence in the pathophysiological underlying mechanism.

Biography :

Simone Famularo graduated in July 2015 at Sapienza University School of Medicine, Rome, Italy. He was trained as a surgeon for four years and was a research fellow in cancer in the hospital of that same university. In September 2015, he won a research fellowship at Royal Marsden Hospital in London, working on the Small for size Syndrome after major hepatectomy. He has published an article regarding this, and currently he is continuing his research on the syndrome in Sapienza University of Rome, focusing on the pathophysiological mechanism of small for size after extended hepatectomy. He cooperates with several international journals as a reviewer.