ADULT-TO-PEDIATRIC LIVING DONOR LIVER TRANSPLANT IN RECIPIENTS >20 KG: A CASE SERIES OF FULL LEFT LOBE GRAFTS

Chile presents one of the lowest organ donation rates, resulting in pediatric liver waitlist mortality rates up to 38.1%. Live donor liver transplantation is one of the main alternatives to decrease waitlist mortality, mostly utilized in our country for small children up to 20 kg.

The aim of this study was to report a three-case series of adult-to-pediatric living donor liver transplantation using a full left lobe graft.

We report three cases of children with more than 20 kg who received complete left hemi-grafts in different clinical scenarios. The indications and techniques adopted are discussed.

Three children, two girls and one boy, aged 11, 7, and 3 years, were transplanted. The indications for transplant were fulminant hepatitis of autoimmune etiology, hepatoblastoma, and chronic liver failure due to autoimmune hepatitis, respectively. The evolution was satisfactory in all three children, and to date, all are well, approximately 12-24 months after the transplant.

The use of a living donor left lateral segment (segments 2 and 3) has been successfully employed in pediatric liver transplantation. However, it is only suitable for infants and low-weight children. This approach using the whole left hemi-liver graft contributes to the reduction of small-for-size syndrome, mortality rate, and waiting times associated with deceased donors.