Large for size in pediatrics liver transplant using left lateral segment grafts: A single center experience

Abstract

Background There are still controversies in using the large left lateral segment in pediatrics LT, with the possibility of the problem of LFS grafts, and the use of monosegmental or reduced liver grafts in small infants. This study aimed to evaluate our experience with LFSG in pediatrics LT. Methods A cohort retrospective analysis was conducted including pediatric recipients who underwent LT between January 2011 and October 2019. We compared recipients with GRWR ≥ 4% (LFS) vs GRWR < 4% as an average for size grafts. Results There were 331 pediatric LT, 74 patients with GRWR ≥ 4%, and 257 patients with GRWR < 4%. In the group of LFS grafts, temporary abdominal closure by silicon patch was done in 39 patients (52.7%), 2 patients (2.7%) had postoperative HAT, 3 patients (4.1%) early PVT, 1 patient (1.3%) bile leak, and 3 patients (4.1%) had wound infection, with no significant difference in these complications between the 2 groups. In patients with LFS‐ grafts, the 1‐, 3‐, 5‐, and 7‐year patients survival rates were 94.6%, 91.7%, 91.7%, and 91.7%, respectively, while the survival rates in patients of the other group were 96.1%, 92.6%, 91.9%, and 91.9%, respectively, with no significant difference (p = .85). Conclusion Using LFS graft by left lateral segment in pediatric LT with potential delayed abdominal closure is a safe and feasible option with good outcomes and unnecessary need for graft reduction if performed by an experienced multidisciplinary team.

An Analysis of 10,000 Cases of Living Donor Liver Transplantation in Japan

“…27,28 In pediatric LDLT, LFS grafts reportedly lead to early graft dysfunction. 29 In the present study, a GRWR > 5 was found to be an independent risk factor for PS, but not the age of the donor. 30,31 In pediatric LDLT in Japan, a GRWR > 4 was reported to be an independent risk factor.…”

“…In pediatric LDLT, LFS grafts reportedly lead to early graft dysfunction 29 . In the present study, a GRWR >5 was found to be an independent risk factor for PS, but not the age of the donor 30,31 .…”

Predictors of portal vein complications after pediatric liver transplantation: A German center experience

“…This, in turn, will increase intrahepatic vascular resistance, decreasing portal blood flow and increasing the incidence of PVT after transplantation. As a result, it is not surprising that many studies, including our own, have reported PVT occurring more frequently within the first week after the transplant 4,11,12 and some authors have suggested using smaller grafts and delaying abdominal wall closure in low weight patients after LT 7,11,16–19 …”

“…This, in turn, will increase intrahepatic vascular resistance, decreasing portal blood flow and increasing the incidence of PVT after transplantation. As a result, it is not surprising that many studies, including our own, have reported PVT occurring more frequently within the first week after the transplant 4,11,12 and some authors have suggested using smaller grafts and delaying abdominal wall closure in low weight patients after LT. 7,11,[16][17][18][19] Studies by Neto et al 11 and de Magnee et al 20 showed that the use of vascular grafts was associated with a greater risk of posttransplant PVT. Nevertheless, in this study, only one vascular graft was used and thus we were unable to determine its possible role in to be associated with PVCs in general and not with PVT specifically.…”

Preoperative computed tomography volumetry and graft weight estimation of left lateral segment in pediatric living donor liver transplantation

“…However, many authors suggest that a good surgical strategy for bigger grafts leads to no inferior results. Also, they have denied the major concerns of delayed abdominal closure, such as the increased possibility of a local wound and abdominal infections 19,20 . In conclusion, an underestimation of liver graft size and associated recipient risks should be considered by using a "one-to-one" rule.…”