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Updated: Oct 23, 2025
Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Pediatric deceased donor liver transplantation with in situ size reduction for recipient-graft size matching
Jung-Man Namgoong1, Shin Hwang1, Dae-Yeon Kim1
1Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
This study details a pediatric liver transplant using a reduced whole liver graft for a young boy with biliary atresia. The successful surgery involved in situ graft reduction and achieved a positive outcome four years post-transplant.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplantation Immunology
Background:
- Biliary atresia is a severe condition requiring liver transplantation in pediatric patients.
- Successful liver transplantation in small children presents challenges due to graft size and recipient anatomy.
- The Pediatric End-stage Liver Disease (PELD) score guides transplant candidacy.
Observation:
- A deceased donor liver graft, significantly larger than the recipient's abdominal cavity, was utilized.
- The surgical team performed in situ size reduction of the liver graft.
- Specialized techniques were employed for vascular reconstruction, including a modified piggyback method for outflow veins and side-to-side anastomosis for a hypoplastic portal vein.
Findings:
- In situ reduction of the liver graft was successfully performed, allowing for primary abdominal closure.
- The patient experienced acute rejection episodes post-transplantation.
- The child has maintained good health for four years following the liver transplant.
Implications:
- This case demonstrates the feasibility of using reduced whole liver grafts in pediatric liver transplantation.
- In situ graft reduction is a viable strategy to overcome size mismatch in pediatric liver transplantation.
- Successful long-term outcomes are achievable even with initial graft size challenges and post-transplant rejection episodes.
Abstract:
We present a case of pediatric deceased donor liver transplantation using a reduced whole liver graft in a 25-month-old boy weighing 12.7 kg. After he had undergone Kasai portoenterostomy for biliary atresia, his general condition deteriorated progressively. He was enrolled on the waiting list for liver transplantation with Pediatric End-stage Liver Disease score of 15. The donor was a 51-monthold boy with body weight of 20 kg. The donor-to-recipient body weight ratio was 158%. The liver graft appeared to be larger than the recipient's abdominal cavity. Thus, we planned to do in situ size reduction. Recipient surgery was performed following standard procedures. We performed graft outflow vein reconstruction using a modified piggyback technique like the double inferior vena cava method. Since the portal vein was hypoplastic, a side-to-side anastomosis technique was used. We also performed intraoperative portogram to embolize venous collaterals. After completing the graft implantation, we found that the liver graft was too large to be accommodated within the abdomen. After in situ resection of the left lateral section parenchyma, we successfully performed primary closure of the abdominal wound. This patient experienced episodes of acute rejection. He has been doing well for four years after the transplantation.
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