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KMID : 1143920200240040503
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Annals of Hepato-Biliary-Pancreatic Surgery
2020 Volume.24 No. 4 p.503 ~ p.512
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Pediatric liver transplantation with hyperreduced left lateral segment graft
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Namgoong Jung-Man
Hwang Shin
Song Gi-Won
Kim Dae-Yeon
Ha Tae-Yong
Jung Dong-Hwan
Park Gil-Chun
Ahn Chul-Soo
Kim Kyung-Mo
Oh Seak-Hee
Kwon Hyun-Hee
Kwon Yong-Jae
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Abstract
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Backgrounds/Aims: To prevent large-for-size graft-related complications in small infant patients, the size of a left lateral segment (LLS) graft can be reduced to be a hyperreduced LLS (HRLLS) graft.
Methods: This study was intended to describe the detailed techniques for harvesting and implanting HRLLS grafts developed in a high-volume liver transplantation (LT) center.
Results: The mean recipient age was 4.0±1.7 months (range: 3-6) and body weight was 5.3±1.4 kg (range: 4.1-6.9). Primary diagnoses of the recipients were progressive familial intrahepatic cholestasis in 2 and biliary atresia in 1. The types of LT were living donor LT in 1 and split deceased donor LT in 2. Non-anatomical size reduction was performed to the transected LLS grafts. The mean weight of the HRLLS grafts was 191.7±62.1 g (range: 120-230) and graft-recipient weight ratio was 3.75±1.57% (range: 2.45-5.49). Widening venoplasty was applied to the graft left hepatic vein outflow orifice. Vein homograft interposition was used in a case with portal vein hypoplasia. Types of the abdomen wound closure were one case of primary repair, one of two-staged closure with a mesh, and one of three-staged repair with a silo and a mesh. All three patients recovered uneventfully from the LT operation and are doing well to date for more than 6 years after transplantation.
Conclusions: Making a HRLLS graft through non-anatomical resection during living donor LT and split deceased donor LT can be a useful option for treating small infant patients.
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KEYWORD
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Infant, Large-for-size graft, Pediatric transplantation, Graft-recipient weight ratio, Left lateral segment
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