title: Living donor liver transplantation with left liver graft.
abstract: Small-for-size syndrome in LDLT is associated with graft exposure to excessive portal perfusion. Prevention of graft overperfusion in LDLT can be achieved through intraoperative modulation of portal graft inflow. We report a successful LDLT utilising the left lobe with a GV/SLV of only 20%. A 43 year-old patient underwent to LDLT at our institution. During the anhepatic phase a porto-systemic shunt utilizing an interposition vein graft anastomosed between the right portal branch and the right hepatic vein was performed. After graft reperfusion splenectomy was also performed. Portal vein pressure, portal vein flow and hepatic artery flow were recorded. A decrease of portal vein pressure and flow was achieved, and the shunt was left in place. The recipient post-operative course was characterized by good graft function. Small-for-size syndrome by graft overperfusion can be successfully prevented by utilizing inflow modulation of the transplanted graft. This strategy can permit the use of left lobe in adult-to-adult living donor liver transplantation.
authors.affiliation: Liver and Multivisceral Transplant Center, University of Modena and Reggio Emilia, Modena, Italy. masetti.michele@unimo.it
authors.forename: Michele
authors.initials: M
authors.lastname: Masetti
authors.forename: Antonio
authors.initials: A
authors.lastname: Siniscalchi
authors.forename: Lesley
authors.initials: L
authors.lastname: De Pietri
authors.forename: Vanessa
authors.initials: V
authors.lastname: Braglia
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Benedetto
authors.forename: Nicola
authors.initials: N
authors.lastname: Di Cautero
authors.forename: Bruno
authors.initials: B
authors.lastname: Begliomini
authors.forename: Antonio
authors.initials: A
authors.lastname: Romano
authors.forename: Charles M
authors.initials: CM
authors.lastname: Miller
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ramacciato
authors.forename: Antonio D
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008099:Liver / Q000098:blood supply*; D016031:Liver Transplantation; D019520:Living Donors; D012038:Regeneration