Adult-to-adult living donor liver transplantation (AA-LDLT) is an established treatment option for selected patients with end-stage liver disease. However, its widespread application is limited by the liver volume that can be safely resected from a living donor because a sufficient volume is also required for the recipient. Use of a right lobe graft is widely recommended in AA-LDLT because it can provide sufficient volume to the recipient. 1 However, in comparison with the left lobe graft, the right lobe graft imposes a burden on the donor due to the smaller residual liver volume in the donor. 2 Moreover, the recipient operation with the right lobe graft may be more complicated in consequence of the reconstruction of middle hepatic vein tributaries and plural bile duct. On the other hand, the main problem in using the left lobe graft in AA-LDLT is the small-for-size graft syndrome (SFSGS). 3 The size of the graft required for successful liver transplantation is 30%-40% of the expected liver volume for the recipient or 0.8%-1.0% of the body weight. 4 It is reported that excessive portal venous inflow is a determining factor for injury to endothelial cells and hepatic parenchyma related to SFSGS. 5 A better understanding of the pathophysiology of the small-for-size graft may lead to logical approaches for improving subsequent allograft function. In recent reports, a permanent portacaval (PC) shunt was developed to resolve SFSGS. [5][6][7] Partial diversion of the portal flow to the systemic circulation through a PC shunt may be a reasonable approach for attenuating these injuries. However, in this technique, there is every possibility of disturbing appropriate graft regeneration after liver transplantation because a sufficient amount of portal blood does not flow into the graft permanently. In