BACKGROUND: Size mismatch, which might result in small-for-size syndrome, is still a major limitation of liver transplantation. Prior data has suggested that a graft-to-recipient weight ratio <0.8% was a risk factor for developing small-for-size syndrome.

CASE REPORT: We report the case of a 60-year-old woman who received a whole liver graft, with an estimated graft-to-recipient weight ratio of 0.46%, from a 10-year-old child donor weighing 12.8 kg pre-operatively. Delicate graft inflow modulation was performed according to the intra-operative hemodynamic changes, including portal vein flow, hepatic artery flow, portal vein pressure, and hepatic venous pressure gradient, to avoid small-for-size syndrome.

CONCLUSIONS: The post-transplant course was uneventful and satisfactory. To the best of our knowledge, this is the first reported case of a successful adult deceased donor liver transplantation using a whole liver graft from a brain-dead pediatric donor.

Keywords: Antigenic Modulation, Body Weight, Liver Transplantation