Monosegmental liver transplantation

Strong, Russell W.; Lynch, Stephen V.; Yamanaka, Junichi; Kawamoto, Shunji; Pillay, Praga; Ong, T. H.

doi:10.1016/s0039-6060(05)80283-1

Cited by 47 publications

(44 citation statements)

References 4 publications

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“…The graft reduction can be performed in situ, during the donor operation, or as a back table procedure with use of segment II or III as a graft. [9][10][11][12][13] In our series, we performed reduction after the vascular anastomosis was finished in 1 patient who weighed only 5 kg. An advantage of this technique is that when the liver is placed in the abdominal cavity, reduction is not performed when it is not required.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

Untitled

2015

Exp Clin Transplant

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“…The monosegment graft was first introduced by Strong et al in 1995 [3], and the S3 graft was used in early studies. The monosegment graft enables an effective reduction in GRWR compared with a hyerreduced graft.…”

Section: Discussionmentioning

confidence: 99%

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

Sakuma

Sasanuma

Miki

et al. 2016

Transplantation Proceedings

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“…Couinaud and Houssin described the theoretical feasibility of implanting a single segment. 3 They concluded that segments II, VII, and VIII could be reduced separately. Strong et al 3 described a case in which segment III was obtained on the back table after having resected segment II of a left lobe from a cadaver donor.…”

Section: Discussionmentioning

confidence: 99%

Partial left lateral segment transplant from a living donor

et al. 2000

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A shortage of liver donors for low-weight transplant recipients has prompted the development of procedures for liver-reduction, split-liver, and living related donor transplantations. For pediatric recipients weighing less than 10 kg, the left lateral segment is often still too large. We describe the procedure of monosegmental transplantation using segment II after segment III was resected in situ from a living related donor. Successful monosegmental transplantation is technically feasible and is a valid alternative to be considered for cases of size discrepancy between the recipient's volume and the donor's left lateral segment. Copyright 2000 by the American Association for the Study of Liver DiseasesT he main obstacle to the development of pediatric liver transplantation is the disparity between available small-sized donors and the exponential growth of waiting lists. This situation is even worse when recipients weigh less than 10 kg. The development of procedures for liver-reduction, split-liver, and living related donor transplantations has partially palliated this situation. There is a group of low-weight pediatric patients who cannot benefit from these procedures, either because the left lateral segment of a cadaver donor is too big for the recipient's abdomen or because this segment taken from a living donor was, until recently, the maximum reduction that could be achieved. Living related donors are frequently ruled out because the sizes of segments II and III exceed the recipient's abdominal capacity. Under these circumstances, implantation of a single segment can save the life of infant patients. This report discusses the use of pediatric monosegmental transplantation using a liver segment resected in situ from a living related donor. Materials and Methods Case PresentationsPatient 1 is an 8-month-old girl, weighing 7.25 kg, with biliary atresia who underwent transplantation from a living related donor in March 1997. The donor mother was 26 years old and weighed 64 kg.Patient 2 is an 11-month-old girl, weighing 7 kg, with a history of Kasai-type portal enterostomy at the age of 3 months caused by biliary atresia who underwent transplantation from a living related donor in April 1998. The donor father was 28 years old and weighed 56 kg. Surgical ProcedureDonor surgery. Abdominal approach by bilateral subcostal incision was used. The falciform and left triangular ligaments were sectioned, as well as the pars flaccida and condensa of the gastrohepatic omentum. After dissecting the portal vascular pedicle and the left hepatic vein, intraoperative ultrasound was used to confirm the distribution of these structures in the left lateral segment. Once the portal structures (hepatic artery, portal vein, and bile duct) and the left hepatic vein were isolated, the liver parenchyma was excised well to the right of the attachment of the falciform ligament (Fig. 1). The portal pedicle was identified with ultrasound guidance within the left lateral segment, and the parenchyma was sectioned caudal to the portal path (F...

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Monosegmental liver transplantation

Cited by 47 publications

References 4 publications

Untitled

Untitled

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

Partial left lateral segment transplant from a living donor

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