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

Pediatric liver transplantation in small children is a technical challenge; the use of liver grafts from living donors improves access but faces further technical difficulties due to size mismatch and anatomical variants. Avoiding outflow complications is a major concern in pediatric liver transplantations.

A 14-month-old girl weighing 6.2 kg with extrahepatic biliary atresia without ascites was referred to our hospital. Her father volunteered to donate, and the calculated volume of the left lateral section was 315 mL, with an estimated ratio of 4.5. Segment-3 vein drained into the middle hepatic vein. Given the high graft ratio, variant venous anatomy, and absence of ascites, a segment-2 monosegment graft was planned with a final ratio of 2.8, with no need for venous reconstruction and primary abdominal closure. No technical complications were observed after 6 years of follow-up.

This is the first case of monosegmental liver transplantation in Mexico. The use of this strategy, in the setting of aberrant hepatic vein anatomy, showed that the procedure can avoid unnecessary venous reconstruction and reduce the need for abdominal wall reconstruction or reintervention for closure.