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Published on: May 23, 2025
Left Lateral Segment Liver Transplantation in Small Infants: Outcomes From a High-Volume Center
Helena Linge1, Eva-Doreen Pfister2, Vanessa Muth1
1Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.
Background:
Graft selection in small infants is challenging due to size mismatch and the associated risk of vascular or biliary complications.
Methods:
In this retrospective single-center study, 57 pediatric liver transplants using left lateral segment grafts performed between 2019 and 2024 were analyzed and compared by recipient weight (< 10 kg vs. ≥ 10 kg).
Results:
Overall graft survival was 88% in the < 10 kg group and 96% in the ≥ 10 kg group. Patient survival at 1, 2, and 4 years was similar between groups (p = 0.500). The graft-to-recipient weight ratio was significantly higher in smaller recipients (4.64% vs. 2.37%, p < 0.05), and hepatic artery thrombosis occurred only in this group (9%). Biliary complications were comparable between cohorts (27% vs. 30%). Acute cellular rejection (57% vs. 12%, p < 0.001) and 90-day readmissions (57% vs. 27%, p = 0.022) were significantly more common in children weighing ≥ 10 kg.
Conclusion:
In this selected cohort, left lateral segment transplantation was associated with excellent outcomes across weight groups. Acceptable results in small infants were achieved despite higher GRWR in a specialized setting, supporting LLS grafts as an important option to improve access to timely pediatric transplantation.
