Objective:To investigate some surgical problems about the prevention and treatment of small-for-size syndrome after living donor liver transplantation(LDLT). Methods:LDLT was performed in 59 cases from February 2002 to October 2008. The clinical data were analyzed retrospectively. Four cases whose graft-recipient weight ratio (GRWR)were≤0.8%,were evaluated as small-for-size graft. Angioplasty and vascular graft provide unobstructed outflow,microsurgery,vascular graft and artery plasty were applied in hepatic artery reconstruction. Results:One case was diagnosed as small-for-size syndrome only and recovered four weeks later with suitable drug treatment. Recipients were followed up for 17 to 90 months with no death. Conclusion:On the premise of donor’s safety,much liver graft procurement,a large outflow, high-quality reconstruction of hepatic artery and portal vein are the key points to prevent the incidence of small-for-size syndrome.