title: Technical considerations of living donor hepatectomy of segment 2 grafts for infants.
abstract: BACKGROUND
  The selection of an adequate graft to mitigate the problems associated with a large-for-size graft is essential to ensure the success of liver transplantation for smaller children. Reduced left lateral segment (LLS) grafts have been introduced to overcome this issue.
  
  
  METHODS
  Five infants underwent living donor liver transplantation (LDLT) with segment 2 grafts. In the preoperative assessment, the graft-to-recipient weight ratio (GRWR) and the ratio of the thickness of the donor LLS were used as a reference index for graft size matching, and a 3-dimensional (3D) computer-generated model of the donor liver was used for the analysis of the intrahepatic vasculature. During the donor operation, the relevant portal vein branches feeding to the reduced part of segment 3 were first exposed and divided, and then the parenchymal transection was performed.
  
  
  RESULTS
  Segment 2 grafts were selected in 3 cases and reduced segment 2 grafts were selected in the other 2 cases. The graft reduction was achieved with 46.6 ± 8.2% of the actual LLS, and thus the GRWR was reduced from 5.33 ± 2.09% to 2.70 ± 0.82%. The actual graft thickness was reduced by approximately half after the graft reduction. Primary abdominal closure was performed in all of the recipients. No surgical complications occurred in any of the donors or recipients.
  
  
  CONCLUSIONS
  A segment 2 graft could be a valuable option for graft type selection in LDLT for smaller children. Precise planning using a 3D computer-generated model of the donor liver and meticulous operative procedures are necessary to obtain a viable graft.
authors.affiliation: Division of Transplant Surgery, National Center for Child Health and Development, Tokyo, Japan. Electronic address: sakamoto-si@ncchd.go.jp.
authors.forename: Seisuke
authors.initials: S
authors.lastname: Sakamoto
authors.affiliation: Division of Transplant Surgery, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kanazawa
authors.affiliation: Division of Transplant Surgery, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Takanobu
authors.initials: T
authors.lastname: Shigeta
authors.affiliation: Division of Transplant Surgery, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Uchida
authors.affiliation: Division of Transplant Surgery, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Sasaki
authors.affiliation: Division of Transplant Surgery, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Ikumi
authors.initials: I
authors.lastname: Hamano
authors.affiliation: Division of Transplant Surgery, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Akinari
authors.initials: A
authors.lastname: Fukuda
authors.affiliation: Division of Radiology, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Nosaka
authors.affiliation: Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Egawa
authors.affiliation: Division of Transplant Surgery, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
mesh_terms: D000328:Adult; D000465:Algorithms; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male