*Purpose: The small-for-size syndrome has to be overcome especially in living donor liver transplantation (LDLT) considering the graft and patient survival and morbidities. We introduce 2 liver transplant recipients with successful management of small-for-size syndrome

*Methods: Medical record was retrospectively reviewed.

*Results: The first case was 58-years old male patient who underwent LDLT using right posterior section graft for hepatitis B related cirrhosis and hepatocellular carcinoma. Preoperative laboratory findings were as follow (total bilirubin: 2.49mg/dl, PT INR: 1.23, platelet count: 81000/uL, creatinine: 0.84mg/dl). There was no ascites and prominent splenorenal shunt, and no portal vein thrombus. The graft-recipient weight ratio (GRWR) was 0.64. Hepatic venous pressure gradient (HVPG) after arterial anastomosis was 11 mmHg. Until the postoperative 9^th day, the amount of ascites was increased to1095cc/day and serum bilirubin was decreased but had plateau level at 6.67mg/dl (postoperative 1-day bilirubin was 8.86mg/dl). We started somatostatin (3.5ug/kg/hr) for 5 days and drain amount was decreased to 100cc/day, and bilirubin level was also decreased to 4.33mg/dl. We removed the abdominal drain and his bilirubin was decreased to 1.33mg/dl in the postoperative 40 days and discharged without any complications.The second case was 64-years old male patient who underwent LDLT using left lobe graft for hepatitis B related cirrhosis and hepatocellular carcinoma. Preoperative laboratory findings were as follow (total bilirubin: 1.08mg/dl, PT INR: 1.62, platelet count: 89000/uL, creatinine: 1.05mg/dl). There was no ascites and no prominent collateral vessels. The graft weight was 596g and GRWR was 0.75. After arterial anastomosis, portal flow was 2512 ml/min, and HVPG was 15 mmHg. We performed splenic artery ligation. However, HVPG was still high at 11 mmHg. We decided to use somatostatinin on 2nd postoperative day and used for 9 days. His initial serum bilirubin was 3.74 mg/dl and ascites was 2220 cc/day. Bilirubin and ascites were decreased to 1.65 mg/dl and 700 cc/day respectively. He underwent percutaneous drainage tube for biliary leakage at postoperative 30 days and cytomegalovirus treatment and discharged at postoperative 54 days.

*Conclusions: We experienced somatostatin as a good treatment option for the patient with small graft or those with high portal pressure during the liver transplantation

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