Pediatric liver transplantation with hyperreduced left lateral segment graft

Area of Science:

• Hepatobiliary Surgery
• Pediatric Transplantation
• Surgical Techniques

Background:

• Large-for-size graft complications pose risks in infant liver transplantation (LT).
• Left lateral segment (LLS) grafts can be reduced to hyperreduced LLS (HRLLS) grafts to mitigate these risks.

Purpose of the Study:

• To detail the surgical techniques for harvesting and implanting hyperreduced left lateral segment (HRLLS) grafts.
• To present the outcomes of using HRLLS grafts in small infant patients undergoing liver transplantation.

Main Methods:

• Non-anatomical size reduction of transected LLS grafts.
• Application of widening venoplasty for the graft left hepatic vein outflow orifice.
• Use of vein homograft interposition for portal vein hypoplasia and varied abdominal wound closure techniques.

Main Results:

• Three infant patients (3-6 months, 4.1-6.9 kg) with biliary atresia or progressive familial intrahepatic cholestasis received HRLLS grafts.
• Graft-recipient weight ratio ranged from 2.45-5.49% (mean 3.75±1.57%).
• All patients achieved uneventful recovery and remained well for over 6 years post-transplantation.

Conclusions:

• Hyperreduced left lateral segment (HRLLS) grafts created via non-anatomical resection are a valuable option for pediatric liver transplantation.
• This technique is effective in both living donor LT and split deceased donor LT for small infant recipients.