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Hyper-reduced grafts in living donor liver transplant: Techniques and outcomes
Soumyadip Sain1, Hirak Pahari2, Shikhar Tripathi1
1Department of GI Surgery, Sir Ganga Ram Hospital, New Delhi 110060, India.
Insights
Hyper-reduced left lateral segment (HRLLS) and monosegmental grafts (MSG) are effective for pediatric liver transplantation in small infants. These techniques achieve high survival rates and mitigate complications associated with large grafts.
Area of Science:
- Pediatric Surgery
- Transplantation Immunology
- Hepatology
Background:
- Pediatric liver transplantation (LT) is crucial for end-stage liver disease.
- Graft size mismatch is a major challenge in infants (<10 kg).
- Large-for-size grafts risk vascular thrombosis and poor perfusion.
Purpose of the Study:
- To analyze techniques and outcomes of hyper-reduced left lateral segment (HRLLS) and monosegmental grafts (MSG) in pediatric LT.
- Evaluate graft modification strategies for small recipients.
Main Methods:
- Systematic review and meta-analysis following PRISMA guidelines.
- Literature search of PubMed, Scopus, and Google Scholar up to Feb 2025.
- Quality assessment using Joanna Briggs Institute Critical Appraisal Checklist.
Main Results:
- Included 18 studies on graft reduction techniques.
- HRLLS and MSG showed comparable one-year survival rates >80% (some >95%).
- Complications (e.g., thrombosis, sepsis) were slightly higher but acceptable; no significant survival difference between graft types.
Conclusions:
- HRLLS and MSG enable successful pediatric LT in small recipients.
- Achieve long-term outcomes comparable to standard grafts.
- Expand donor pool and optimize survival while reducing complications.
Background:
Pediatric liver transplantation (LT) is the definitive treatment for end-stage liver disease and acute liver failure in children. However, graft size mismatch poses significant challenges, particularly in infants weighing less than 10 kg. Large-for-size grafts can lead to severe complications, including vascular thrombosis and impaired graft perfusion. Surgical innovations, such as hyper-reduced left lateral segment (HRLLS) grafts and monosegmental grafts (MSG), offer viable solutions by tailoring graft size without compromising vascular or biliary integrity.
Aim:
To analyze the techniques and outcomes of HRLLS and MSG grafts in pediatric liver trabsplantation.
Methods:
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive literature search was conducted across PubMed, Scopus, and Google Scholar, including studies up to February 2025. Eligible studies included case-control, observational, and randomized controlled trials reporting clinical outcomes of HRLLS, MSG, or reduced left lateral segment grafts (RLLS) in pediatric LT. The Joanna Briggs Institute Critical Appraisal Checklist was used for quality assessment. Meta-analysis was performed using MetaXL software to pool survival outcomes and assess complication profiles.
Results:
Eighteen studies involving various graft reduction techniques were included. Both HRLLS and MSG demonstrated comparable one-year survival rates exceeding 80%, with some studies reporting rates above 95%. Complications such as hepatic artery thrombosis, portal vein thrombosis, and sepsis were slightly more frequent in HRLLS/RLLS recipients but remained within acceptable limits. Meta-analysis revealed no significant differences in survivability between graft types.
Conclusion:
HRLLS and MSG techniques enable successful liver transplantation in small pediatric recipients, achieving long-term outcomes comparable to standard approaches. These graft modification strategies expand donor pool utilization and optimize patient survival while mitigating large-for-size complications.
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