Living donor liver transplantation with hyperreduced left lateral segments

Kasahara, Mureo; Fukuda, Akira; Yokoyama, Shinji; Sato, Shuichi; Tanaka, Hideaki; Kuroda, Takeshi; Honna, Toshiro

doi:10.1016/j.jpedsurg.2008.02.056

Cited by 54 publications

(59 citation statements)

References 9 publications

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“…After isolation of the donor left hepatic artery, hepatic duct, and portal branch, the hepatic parenchyma of the medial segment was transected 5 mm to the right side of the falciform ligament without blood inflow occlusion or graft manipulation. The left lateral segments of the donors were reduced in situ in hyper-reduced left lateral grafts if the estimated graft-torecipient weight ratio was more than 4.0%, as previously reported [6].…”

Section: Methodsmentioning

confidence: 92%

See 1 more Smart Citation

Portal vein reconstruction in pediatric living donor liver transplantation for patients younger than 1 year with biliary atresia

Kanazawa

Sakamoto

Fukuda

et al. 2012

Journal of Pediatric Surgery

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Section: Methodsmentioning

confidence: 92%

“…Six patients (17.6%) received blood type incompatible grafts. Seventeen patients (50.0%) received hyper-reduced left lateral segment grafts [6]. The preoperative PV diameter and mean velocity were measured with Doppler ultrasonography (US) by two experienced radiologists (O.M.…”

Section: Methodsmentioning

confidence: 99%

Portal vein reconstruction in pediatric living donor liver transplantation for patients younger than 1 year with biliary atresia

Kanazawa

Sakamoto

Fukuda

et al. 2012

Journal of Pediatric Surgery

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“…14,15 In our study, we did not have any graft loss, graft necrosis, or vascular thrombosis due to LFSS. However, vascular kinking was observed in 15 patients, and this was treated with Bogota bag technique or skin closure without fascia closure.…”

Section: Discussionmentioning

confidence: 85%

Untitled

2015

Exp Clin Transplant

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Objectives: The ideal ratio between liver transplant graft mass and recipient body weight is unknown, but the graft probably must weigh 0.8% to 2.0% recipient weight. When this ratio > 4%, there may be problems due to large-for-size transplant, especially in recipients < 10 kg. This condition is caused by discrepancy between the small abdominal cavity and large graft and is characterized by decreased blood supply to the liver graft and graft dysfunction. We evaluated our experience with large-for-size grafts. Materials and Methods: We retrospectively evaluated 377 orthotopic liver transplants that were performed from 2001-2014 in our center. We included 188 pediatric transplants in our study. Results: There were 58 patients < 10 kg who had living-donor living transplant with graft-to-bodyweight ratio > 4%. In 2 patients, the abdomen was closed with a Bogota bag. In 5 patients, reoperation was performed due to vascular problems and abdominal hypertension, and the abdomen was closed with a Bogota bag. All Bogota bags were closed in 2 weeks. After closing the fascia, 10 patients had vascular problems that were diagnosed in the operating room by Doppler ultrasonography, and only the skin was closed without fascia closure. No graft loss occurred due to large-for-size transplant. There were 8 patients who died early after transplant (sepsis, 6 patients; brain death, 2 patients). There was no major donor morbidity or donor mortality. Conclusions: Large-for-size graft may cause abdominal compartment syndrome due to the small size of the recipient abdominal cavity, size discrepancies in vascular caliber, insufficient portal circulation, and disturbance of tissue oxygenation. Abdominal closure with a Bogota bag in these patients is safe and effective to avoid abdominal compartment syndrome. Early diagnosis by ultrasonography in the operating room after fascia closure and repeated ultrasonography at the clinic may help avoid graft loss.

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“…Reduced left lateral segment grafts were indicated for recipients who received grafts with an estimated graft-to-recipient body weight > 4.0% since September 2000 (Figure 3). 8 In the 2224 recipients aged < 18 years, the graft types included left lateral segment in 1549 recipients (70%), left lobe in 500 recipients (23%), reduced left lateral segment in 96 recipients (4%), right lobe in 76 recipients (3%), and posterior segment in 3 recipients (0.1%). There was no significant difference in survival between recipients that had different graft types (Figure 4).…”

Section: Resultsmentioning

confidence: 98%

“…Further reducing the size of the left lateral segment increases the possibility of supplying an adequate graft size, and a reduced or hyperreduced left lateral segment may mitigate the problems of large-for-size grafts with graft-to-recipient weight ratio > 4.0%. 8 The Japanese Liver Transplantation Society is a cooperative research consortium that was established in 1980 to characterize and follow trends in patient and graft survival at all liver transplant centers in Japan. The purpose of the present study was to evaluate a large cohort of pediatric patients who had living-donor liver transplant.…”

Section: Introductionmentioning

confidence: 99%

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

Kasahara¹,

Sakamoto²,

Umeshita³

et al. 2014

Exp Clin Transplant

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Objectives: The Japanese Liver Transplantation Society is a cooperative research consortium, established in 1980 to characterize and follow trends in patient and graft survival in all liver transplants in Japan. This study evaluated the effect of graft size matching on survival in pediatric recipients of livingdonor liver transplant. Materials and Methods: Between November 1989 and December 2010, there were 2224 patients aged < 18 years who received living-donor liver transplant in Japan. Survival was evaluated according to graft size matching. Results: There were 998 male and 1226 female donors (median age, 35.2 y). There was no donor mortality associated with surgery. The median age of recipients was 4.0 years (range, 13 d to 17.9 y) and body weight was 16.6 kg (range, 2.6 to 90 kg). The survival of living-donor liver transplant recipients was greater for pediatric than adult recipients at 1 year (adult, 81%; pediatric, 88%), 5 years (adult, 72%; pediatric, 85%), 10 years (adult, 66%; pediatric, 83%), and 15 years (adult, 57%; pediatric, 80%) after transplant (difference between adult and pediatric recipients: P ≤ .0001). In the 2224 recipients aged < 18 years, the graft types included left lateral segment in 1549 recipients (70%), left lobe in 500 recipients (23%), reduced left lateral segment in 96 recipients (4%), right lobe in 76 recipients (3%), and posterior segment in 3 recipients (0.1%). There was no significant difference in survival between recipients that had different graft types. However, recipients aged < 1 year (296 recipients) who received grafts with graft-to-recipient body weight ratio > 4.0% had significantly worse patient survival because of problems associated with large-for-size grafts. Conclusions: Living-donor liver transplant had greater survival in children than adult recipients. Graft-to-recipient body weight ratio was a significant prognostic factor in recipients aged < 1 year.

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Living donor liver transplantation with hyperreduced left lateral segments

Cited by 54 publications

References 9 publications

Portal vein reconstruction in pediatric living donor liver transplantation for patients younger than 1 year with biliary atresia

Portal vein reconstruction in pediatric living donor liver transplantation for patients younger than 1 year with biliary atresia

Untitled

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

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