title: Pediatric liver transplantation using reduced and hyper-reduced left lateral segment grafts: a 10-year single-center experience.
abstract: Few studies have examined the long-term outcomes and prognostic factors associated with pediatric living living-donor liver transplantation (LDLT) using reduced and hyper-reduced left lateral segment grafts. We conducted a retrospective, single-center assessment of the outcomes of this procedure, as well as clinical factors that influenced graft and patient survival. Between September 2000 and December 2009, 49 patients (median age: 7 months, weight: 5.45 kg) underwent LDLT using reduced (partial left lateral segment; n = 5, monosegment; n = 26), or hyper-reduced (reduced monosegment grafts; n = 18) left lateral segment grafts. In all cases, the estimated graft-to-recipient body weight ratio of the left lateral segment was more than 4%, as assessed by preoperative computed tomography volumetry, and therefore further reduction was required. A hepatic artery thrombosis occurred in two patients (4.1%). Portal venous complications occurred in eight patients (16.3%). The overall patient survival rate at 1, 3 and 10 years after LDLT were 83.7%, 81.4% and 78.9%, respectively. Multivariate analysis revealed that recipient age of less than 2 months and warm ischemic time of more than 40 min affected patient survival. Pediatric LDLT using reduced and hyper-reduced left lateral segment grafts appears to be a feasible option with acceptable graft survival and vascular complication rates.
authors.affiliation: Department of Hepatobiliary, Pancreas and Transplant Surgery, Kyoto University, Kyoto, Japan.
authors.forename: M R
authors.initials: MR
authors.lastname: Shehata
authors.forename: S
authors.initials: S
authors.lastname: Yagi
authors.forename: Y
authors.initials: Y
authors.lastname: Okamura
authors.forename: T
authors.initials: T
authors.lastname: Iida
authors.forename: T
authors.initials: T
authors.lastname: Hori
authors.forename: A
authors.initials: A
authors.lastname: Yoshizawa
authors.forename: K
authors.initials: K
authors.lastname: Hata
authors.forename: Y
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: K
authors.initials: K
authors.lastname: Ogawa
authors.forename: S
authors.initials: S
authors.lastname: Okamoto
authors.forename: Y
authors.initials: Y
authors.lastname: Ogura
authors.forename: A
authors.initials: A
authors.lastname: Mori
authors.forename: S
authors.initials: S
authors.lastname: Teramukai
authors.forename: T
authors.initials: T
authors.lastname: Kaido
authors.forename: S
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D005260:Female; D006084:Graft Rejection; D006085:Graft Survival / Q000502:physiology*; D006499:Hepatic Artery / Q000473:pathology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D011169:Portal Vein / Q000473:pathology*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013927:Thrombosis / Q000209:etiology / Q000401:mortality