Monosegmental Reduction as Strategy to Simplify Venous Reconstruction During Pediatric Liver Transplantation

Area of Science:

• Hepatobiliary surgery
• Pediatric transplantation
• Surgical innovation

Background:

• Pediatric liver transplantation presents significant technical challenges, especially in small children.
• Living donor liver grafts improve access but introduce difficulties like size mismatch and anatomical variations.
• Preventing outflow complications is critical in pediatric liver transplant procedures.

Observation:

• A 14-month-old girl (6.2 kg) with extrahepatic biliary atresia underwent evaluation for liver transplantation.
• A left lateral section graft was initially considered, but variant venous anatomy (Segment-3 vein to middle hepatic vein) prompted a change in strategy.
• A segment-2 monosegment graft was chosen, providing a 2.8 graft-to-recipient weight ratio.

Findings:

• The monosegment liver transplant was performed without the need for venous reconstruction.
• Primary abdominal closure was achieved.
• The patient experienced no technical complications during a 6-year follow-up period.

Implications:

• This case demonstrates the feasibility of monosegment liver transplantation in pediatric patients with aberrant hepatic vein anatomy.
• This strategy can circumvent the need for complex venous reconstruction, simplifying the surgical procedure.
• It potentially reduces the necessity for abdominal wall reconstruction or reoperation for closure in pediatric liver transplants.