Related Experiment Video
Updated: Nov 28, 2025
Re-Arterialized Rat Partial Liver Transplantation with an in vivo Vessel-Oriented 70% Hepatectomy
Published on: April 8, 2018
Pediatric liver transplantation with hyperreduced left lateral segment graft
Jung-Man Namgoong1, Shin Hwang1, Gi-Won Song1
1Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Hyperreduced left lateral segment (HRLLS) grafts are a viable option for infant liver transplantation (LT), reducing complications in small recipients. This technique offers a successful solution for pediatric liver disease.
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.
Backgrounds/Aims:
To prevent large-for-size graft-related complications in small infant patients, the size of a left lateral segment (LLS) graft can be reduced to be a hyperreduced LLS (HRLLS) graft.
Methods:
This study was intended to describe the detailed techniques for harvesting and implanting HRLLS grafts developed in a high-volume liver transplantation (LT) center.
Results:
The mean recipient age was 4.0±1.7 months (range: 3-6) and body weight was 5.3±1.4 kg (range: 4.1-6.9). Primary diagnoses of the recipients were progressive familial intrahepatic cholestasis in 2 and biliary atresia in 1. The types of LT were living donor LT in 1 and split deceased donor LT in 2. Non-anatomical size reduction was performed to the transected LLS grafts. The mean weight of the HRLLS grafts was 191.7±62.1 g (range: 120-230) and graft-recipient weight ratio was 3.75±1.57% (range: 2.45-5.49). Widening venoplasty was applied to the graft left hepatic vein outflow orifice. Vein homograft interposition was used in a case with portal vein hypoplasia. Types of the abdomen wound closure were one case of primary repair, one of two-staged closure with a mesh, and one of three-staged repair with a silo and a mesh. All three patients recovered uneventfully from the LT operation and are doing well to date for more than 6 years after transplantation.
Conclusions:
Making a HRLLS graft through non-anatomical resection during living donor LT and split deceased donor LT can be a useful option for treating small infant patients.
More Related Videos
13:57Laparoscopic Anatomical Liver Segment VII Resection with Liver Parenchymal Transection Following a Priority Approach
Published on: May 23, 2025
18:47Surgical Procedures for a Rat Model of Partial Orthotopic Liver Transplantation with Hepatic Arterial Reconstruction
Published on: March 7, 2013