title: Transplantation with hyper-reduced liver grafts in children under 10 kg of weight.
abstract: BACKGROUND
  We had previously described a left lateral segment hyper-reduction technique capable of sizing the graft according to the volume of the abdominal cavity of the recipient.
  
  
  OBJECTIVE
  The purpose of our study was to evaluate our 14-year live-donor liver transplantation experience with in situ graft hyper-reduction in children under 10 kg of weight.
  
  
  METHODS
  Between January 1997 and May 2011, we performed 881 liver transplants. Two hundred and seventy-seven (n = 277) involved pediatric recipients, of which 102 (37 %) were from live donors. Thirty-five (n = 35) patients under 10 kg of weight underwent hyper-reduced living donor liver transplants. There were 21 females (60 %) and 14 males (40 %), with a median age of 12 months (range 3-23) and a median weight of 7.7 kg (range 5.6-10).
  
  
  RESULTS
  Median operative time was 350 min (range 180-510). Median cold ischemia time was 180 min (range 60-300). Twenty-six (n = 26) patients required intraoperative transfusion of blood products. There were 49 postoperative complications involving 26 patients (74 % morbidity rate). One-, 3-, and 5-year survival rates were 87, 79, and 74 %, respectively. Twenty-eight patients are currently alive.
  
  
  CONCLUSIONS
  Hyper-reduced grafts provide an alternative approach for low-weight pediatric recipients. The relatively high immediate postoperative morbidity could be related to the complexity of these patients.
authors.affiliation: General Surgery and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Gascón 450, Buenos Aires, Argentina. victoria.ardiles@hospitalitaliano.org.ar
authors.forename: Victoria
authors.initials: V
authors.lastname: Ardiles
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Ciardullo
authors.forename: Daniel
authors.initials: D
authors.lastname: D'Agostino
authors.forename: Juan
authors.initials: J
authors.lastname: Pekolj
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Mattera
authors.forename: Gustavo H
authors.initials: GH
authors.lastname: Boldrini
authors.forename: Claudio
authors.initials: C
authors.lastname: Brandi
authors.forename: Axel F
authors.initials: AF
authors.lastname: Beskow
authors.forename: Ernesto P
authors.initials: EP
authors.lastname: Molmenti
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Santibañes
mesh_terms: D001118:Argentina; D001835:Body Weight; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007223:Infant; D008099:Liver / Q000473:pathology*; D017093:Liver Failure / Q000151:congenital / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D009929:Organ Size; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D015996:Survival Rate; D020858:Tissue and Organ Harvesting / Q000379:methods; D018084:Ultrasonography, Interventional