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Published on: May 23, 2025
Early Morbidity and Survival After Left Lateral Segment Versus Whole Liver Graft Transplantation in Children
Helena Linge1,2, Eva-Doreen Pfister3, Vanessa Muth1
1Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.
Background:
Left lateral segment (LLS) grafts expand graft availability for infants and small children requiring liver transplantation (LT). However, their cumulative early postoperative burden compared with whole liver grafts (WLGs) remains incompletely characterized.
Methods:
This retrospective single-center cohort study included 95 consecutive primary pediatric LT recipients treated between 2019 and 2024, comprising 56 LLS and 39 WLG recipients. Cumulative postoperative morbidity within 90 days was quantified using the Comprehensive Complication Index (CCI). Additional outcomes included biliary and vascular complications, unplanned surgical reinterventions, length of stay, graft loss, retransplantation, and graft and patient survival.
Results:
LLS recipients were younger and smaller than WLG recipients. Cumulative 90-day morbidity was greater after LLS transplantation (median CCI 53 vs. 45, p = 0.002). LLS recipients had higher rates of bile leakage (18% vs. 3%, p = 0.024), intra-abdominal bleeding (15% vs. 0%, p = 0.019), and unplanned surgical reintervention (43% vs. 8%, p < 0.001). Although the overall incidence of biliary complications was similar between groups, anastomotic biliary strictures during follow-up were more frequent after WLG transplantation (28% vs. 9%, p = 0.014). Hospital stay was longer after LLS transplantation (median 43 vs. 27 days, p < 0.001). No statistically significant differences in graft loss, retransplantation, or graft and patient survival were detected between groups.
Conclusions:
LLS transplantation was associated with greater cumulative morbidity within 90 days, characterized by higher rates of bile leakage, intra-abdominal bleeding, unplanned surgical reintervention, and prolonged hospitalization. Despite this greater early postoperative burden, no statistically significant differences in graft loss, retransplantation, or graft and patient survival were detected during the available follow-up. These findings support continued use of LLS grafts to expand transplant access. Given the associated early morbidity, it highlights the importance of an experienced surgical and medical team.
