title: Living-donor liver transplantation with hyperreduced left lateral segment grafts: a single-center experience.
abstract: BACKGROUND
  In the setting of liver transplantation in small infants who receive left lateral segment (LLS) grafts, problems are encountered related to graft-size mismatching in the form of so-called "large-for-size" grafts. To address these problems, the feasibility of further reducing the size of LLS grafts to form hyperreduced LLS (HRLLS) grafts was investigated.
  
  
  METHODS
  Of the 175 pediatric living-donor liver transplantations performed between November 2005 and December 2011 at our institute, 31 cases were performed using HRLLS grafts. The medical records were reviewed and data were collected retrospectively.
  
  
  RESULTS
  The graft-to-recipient body weight ratio was successfully reduced from 5.2% ± 2.0% to 2.9% ± 0.5%. Portal vein thrombosis was observed in one case, and biliary stenosis was seen in two cases. No hepatic artery thrombosis was encountered. The graft and patient 2-year survival rate was 87%. When the results categorized according to the original disease were verified, patients with fulminant hepatic failure (FHF) weighed less and had smaller abdominal cavities compared with patients with cholestatic or metabolic disease. Patients with FHF frequently required skin or partial skin closure to avoid graft compression. For this reason, the anteroposterior diameters in the recipients' abdominal cavities were not adequately large to accommodate the graft thickness, especially in patients with FHF.
  
  
  CONCLUSIONS
  In conclusion, living-donor liver transplantation using HRLLS grafts offers a safe and useful option for treating smaller infants.
authors.affiliation: Department of Transplant Surgery, National Center for Child Health and Development, Tokyo, Japan. kanazawa-hr@ncchd.go.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kanazawa
authors.forename: Seisuke
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Akinari
authors.initials: A
authors.lastname: Fukuda
authors.forename: Hajime
authors.initials: H
authors.lastname: Uchida
authors.forename: Ikumi
authors.initials: I
authors.lastname: Hamano
authors.forename: Takanobu
authors.initials: T
authors.lastname: Shigeta
authors.forename: Megumi
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Chiaki
authors.initials: C
authors.lastname: Karaki
authors.forename: Hideaki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
mesh_terms: D001835:Body Weight; D005260:Female; D006801:Humans; D007223:Infant; D017114:Liver Failure, Acute / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D008297:Male; D019737:Transplants