Liver graft volumetric changes after living donor liver transplantation with segment 2 graft for small infants

Area of Science:

• Hepatology
• Pediatric Surgery
• Transplantation Medicine

Background:

• Liver failure in infants under 5 kg necessitates innovative living donor liver transplantation (LDLT) techniques.
• Transplanting reduced grafts, like modified Couinaud's segment II (S2), is crucial to avoid size mismatch in pediatric LDLT.
• Limited data exists on post-transplant graft volumetric changes in infants receiving reduced grafts.

Purpose of the Study:

• To investigate the volumetric changes of modified S2 grafts after LDLT in small infants.
• To evaluate graft volume (GV) and graft-to-recipient weight ratio (GRWR) dynamics post-transplantation.
• To understand how reduced liver grafts adapt to the recipient's body size.

Main Methods:

• Retrospective analysis of 5 pediatric LDLT cases using monosegment or reduced S2 grafts.
• Serial computed tomography (CT) scans to assess graft volume before and 1, 3 months after LDLT.
• Classification of graft shapes into 'on-table' (OL) and 'later-enlarging' (LL) types.

Main Results:

• All S2 grafts initially increased in volume one month post-LDLT.
• The OL type grafts showed a decrease in volume at three months compared to one month.
• While OL type GRWR tended to decrease, the LL type showed continuous growth, ultimately adapting to the child's body size.

Conclusions:

• Modified S2 grafts exhibit unique volumetric changes following pediatric LDLT.
• These grafts demonstrate adaptive growth, adjusting their volume to achieve an appropriate size relative to the child's weight.
• The findings support the use of reduced S2 grafts in infant LDLT for optimal size matching.