[Reduced-size liver transplants from cadaver and living donors: an alternative to waiting lists]

The ever expanding of indications of liver transplantation in children make pediatric donor pool unable to fulfill the needs. The reduced and partial transplants from cadaveric and living related donors reveal an effort to increase the number of pediatric grafts aid to reduce the mortality in the waiting list. Among 126 pediatric transplants performed in a 8-year period, 18 (15%) were reduced (n = 3) and partial livers (with preservation of the recipient vena cava) (n = 15). In 1993, 41% (n = 12) of the 29 liver transplantations performed were partial segments. In two of them the graft was harvested from a living-related donor. Eight transplants were made on an emergency basis and ten were elective. Eight patients were retransplanted. Considering the transplants performed in the Wisconsin era, after completing the "learning curve" the actuarial survival at five years reaches 65% approaching 70% for patients younger than 1 year and/or weighing less than 13 kg. The arterial complications in this group are limited to a single case of thrombosis. Despite our limited experience we conclude that reduced and partial transplants are useful to reduce the mortality in the waiting list with a survival similar to that of the whole grafts and with less vascular complications. The living-related transplant represents another step ahead that allows a further reduction of the shortage of organ available for the small children.