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Updated: Sep 6, 2025
Re-Arterialized Rat Partial Liver Transplantation with an in vivo Vessel-Oriented 70% Hepatectomy
Published on: April 8, 2018
Pediatric split liver transplantation using a hyperreduced left lateral segment graft in an infant weighing 4 kg
Jung-Man Namgoong1, Shin Hwang1, Dae-Yeon Kim1
1Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Split liver transplantation (LT) using a hyperreduced left lateral segment graft is a viable option for infants with end-stage liver disease. This technique offers a life-saving solution, though challenges with graft size require careful management.
Area of Science:
- Hepatobiliary surgery
- Pediatric transplantation
- Organ preservation and splitting
Background:
- Progressive familial intrahepatic cholestasis (PFIC) necessitates liver transplantation (LT) in infants.
- Split LT is a strategy to address donor organ shortages in pediatric recipients.
- Hyperreduction of grafts is explored to optimize graft size for small infants.
Observation:
- A 106-day-old infant (4 kg) with PFIC received a split liver graft from a 63.7 kg deceased donor.
- The left lateral segment (LLS) was hyperreduced in situ to a weight of 225 g (5.5% graft-recipient weight ratio).
- Multi-stage abdominal closure was required due to the large-for-size graft.
Findings:
- Successful split LT was achieved using a hyperreduced LLS graft.
- The patient demonstrated positive outcomes for over 6 years post-transplantation.
- Graft thickness posed a challenge for abdominal closure, indicating a need for further solutions.
Implications:
- Split LT with hyperreduced grafts is a feasible treatment for infants with PFIC.
- Addressing large-for-size graft issues, particularly graft thickness, is crucial for improving outcomes.
- This approach expands options for pediatric liver transplant candidates facing organ scarcity.
Abstract:
We present a case of successful split liver transplantation (LT) using a hyperreduced left lateral segment (LLS) graft in a 106-day-old female infant patient weighing 4 kg. The patient was diagnosed with progressive familial intrahepatic cholestasis. Her general condition and liver function deteriorated progressively and she was finally allocated for a split LT under status 1. The deceased donor was a 20-year-old female weighing 63.7 kg. We performed in situ liver splitting and in situ size reduction sequentially. The weight of the hyperreduced LLS graft was 225 g, with a graft-recipient weight ratio of 5.5%. We performed recipient hepatectomy and graft implantation according to the standard procedures for pediatric living-donor LT. Since the graft was too large for primary abdomen closure, the abdominal wall was closed in three stages to make a prosthetic silo, temporary closure with a xenograft sheet, and final primary repair over 2 weeks. The patient has been doing well for more than 6 years after transplantation. In conclusion, split LT using a hyperreduced LLS graft can be a useful option for treating small infants. However, large-for-size graft-related problems, particularly in terms of graft thickness, still remain to be solved.
