PORTAL FLOW MODULATION IN LIVING DONOR LIVER TRANSPLANTATION

Background: Small-for-size syndrome is one of the major causes of graft dysfunction after living donor liver transplantation in adults. Excessive portal inflow leading to sinusoidal hyperperfusion and impaired graft function is the primary mechanism of this complication. Effective prevention requires not only morphometric evaluation of the graft but also strict control of portal hemodynamics. Aim of the study is evaluate the effectiveness of graft inflow modulation and determine the prognostic significance of graft-to-recipient weight ratio, spleen-to-graft volume ratio, portal venous flow, and portal venous pressure. Materials and Methods: This study included adult patients who underwent living donor liver transplantation from 2011 to 2025. Portal hemodynamics was assessed intraoperatively. Graft inflow modulation was performed upon detection of portal hyperperfusion( p< 0.05). Results: Patients with small graft volume demonstrated elevated portal venous flow and pressure prior to intervention. Inflow modulation effectively reduced portal venous pressure to physiological levels and was associated with a lower incidence of small-for-size syndrome and reduced mortality. A spleen-to-graft volume ratio greater than 1.0 was linked to significant hyperperfusion and poorer clinical outcomes. Intraoperative modulation proved markedly more effective than delayed postoperative interventions, resulting in higher survival rates and an absence of severe graft dysfunction. Conclusion: Excessive portal inflow is the key determinant of graft dysfunction in living donor liver transplantation. Timely intraoperative modulation of portal blood flow improves hemodynamic stability and enhances survival. A combined assessment of morphometric and hemodynamic parameters enables optimal prevention of small-forsize syndrome and supports a personalized transplantation approach.