Living Donor Liver Transplantation for Neonates Using Segment 2 Monosubsegment Graft

Abstract

The prognosis of liver transplantation for neonates with fulminant hepatic failure (FHF) continues to be extremely poor, especially in patients whose body weight is less than 3 kg. To address this problem, we have developed a safe living donor liver transplantation (LDLT) modality for neonates. We performed LDLTs with segment 2 monosubsegment (S2) grafts for three neonatal FHF. The recipient age and body weight at LDLT were 13-27 days, 2.59-2.84 kg, respectively. S2 or reduced S2 grafts (93-98 g) obtained from their fathers were implanted using temporary portacaval shunt. The recipient portal vein was reconstructed at a more distal site, such as the umbilical portion, to have the graft liver move freely during hepatic artery (HA) reconstruction. The recipient operation time and bleeding were 11 h 58 min-15 h 27 min and 200-395 mL, respectively. The graft-to-recipient weight ratio was 3.3-3.8% and primary abdominal wall closure was possible in all cases. Although hepatic artery thrombosis occurred in one case, all cases survived with normal growth. Emergency LDLT with S2 grafts weighing less than 100 g can save neonates with FHF whose body weight is less than 3 kg. This LDLT modality using S2 grafts could become a new option for neonates and very small infants requiring LT.

Pediatric living donor liver transplantation with large-for-size left lateral segment grafts

“…10,11,17,[24][25][26] In this regard, to optimize the size of the graft matching the recipient's abdominal cavity, it has been suggested that for recipients under 10 kg the GRWR should be < 4%. 10,11,17,[24][25][26] In this regard, to optimize the size of the graft matching the recipient's abdominal cavity, it has been suggested that for recipients under 10 kg the GRWR should be < 4%.…”

Effect of Graft Size Matching on Pediatric Living-donor Liver Transplantation in Japan

“…Reducing the left lateral segment thickness was introduced in neonatal living-donor liver transplant, but this did not improve recipient survival. 9,10 Tailoring the graft size and reducing the thickness of the left lateral segment may enable safe transplant in small children without the associated complications of large-for-size grafts.…”

Living-Donor Liver Transplantation Using Segment 2 Monosegment Graft: A Single-Center Experience

“…The recipient procedure has been described in previous reports [6,7]. As the key part of the recipient operation, we judge whether or not we are able to perform primary abdominal wall closure 3-dimensional computer-generated model of the donor liver was used to analyze the intrahepatic vasculature and to evaluate the graft volume of S2 and S3 following the dominant portal vein branches.…”

“…Following previous reports, we attempted to transplant the S3 graft in small infants. Even though the size of the graft was reduced adequately, the thickness of the graft was not satisfactory for placement in the recipient.We developed a safe LDLT technique for neonates by modifying the previous method, using an anatomical graft or so-called "Segment 2 monosegment graft" (S2 graft) [6]. We believe that the S2 graft enables reduction of not only LLS…”

“…We developed a safe LDLT technique for neonates by modifying the previous method, using an anatomical graft or so-called "Segment 2 monosegment graft" (S2 graft) [6]. We believe that the S2 graft enables reduction of not only LLS…”