title: Implications for the usage of the left lateral liver graft for infants ≤10 kg, irrespective of a large-for-size situation--are monosegmental grafts redundant?
abstract: Organ donor shortage for infant liver transplant recipients has lead to an increase in splitting and living donation. For cases in which even transplantation of the left lateral graft (Couinaud's segments II + III) results in a "large for size situation" with an estimated graft body weight ratio (GBWR) of >4%, monosegmental liver transplantation was developed. This, however, bears complications because of greater parenchymal surface and suboptimal vascular flow. We exclusively use the left lateral graft from living donors or split grafts. Temporary abdominal closure is attempted in cases of increased pressure. We report of 41 pediatric transplants in 38 children ≤10 kg. Within this group, there were 23 cases with a GBWR of ≥4, and 15 cases with a GBWR <4. There was no statistical difference in vascular or biliary complications. Despite a more frequent rate of temporary abdominal closure, we did not find a higher rate of intra-abdominal infections. Overall, patient and graft survival was excellent in both groups (one death, three re-transplants). We noticed, however, that the ventro-dorsal diameter of the graft appears to be more relevant to potential graft necrosis than the actual graft size. In conclusion, the usage of monosegmental grafts seems unnecessary if transplantation of left lateral grafts is performed by an experienced multidisciplinary team, and temporary abdominal closure is favored in cases of increased abdominal pressure.
authors.affiliation: Department of General and Thoracic Surgery, University of Schleswig-Holstein, Campus Kiel, Germany. maren.schulze@uksh-kiel.de
authors.forename: Maren
authors.initials: M
authors.lastname: Schulze
authors.forename: Bettina
authors.initials: B
authors.lastname: Dresske
authors.forename: Julia
authors.initials: J
authors.lastname: Deinzer
authors.forename: Felix
authors.initials: F
authors.lastname: Braun
authors.forename: Martina
authors.initials: M
authors.lastname: Kohl
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schulz-Jürgensen
authors.forename: Jan
authors.initials: J
authors.lastname: Borggrefe
authors.forename: Martin
authors.initials: M
authors.lastname: Burdelski
authors.forename: Dieter Clemens
authors.initials: DC
authors.lastname: Bröring
mesh_terms: D000293:Adolescent; D001724:Birth Weight; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D059413:Intraabdominal Infections / Q000209:etiology; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D009336:Necrosis; D014463:Ultrasonography / Q000379:methods