Small-for-size graft problems in adult-to-adult living-donor liver transplantation.

The number of adult patients undergoing living donor liver transplantation (LDLT) has recently increased. According to a recent Japanese survey, the 5-year survival rate in adults after surgery is only 69.7%, which is significantly poorer than that in pediatric series. Small-for-size grafts remain a problem in adult LDLT. The most commonly used liver graft for adult patients has shifted from the left liver to the right, which alleviates the problem of size disproportion. Right hepatectomy, however, increases the extent of the donor operation and raises an important ethical issue in LDLT. Patients who truly need a right liver graft should be carefully selected using evidence-based criteria.