title: A case of pediatric live-donor liver transplantation with a left lateral segment reduction by a linear stapler after reperfusion.
abstract: In pediatric LDLT, graft reduction is sometimes required because of the graft size mismatch. Dividing the portal triad and hepatic veins with a linear stapler is a rapid and safe method of reduction. We herein present a case with a left lateral segment reduction achieved using a linear stapler after reperfusion in pediatric LDLT. The patient was a male who had previously undergone Kasai procedure for biliary atresia. We performed the LDLT with his father's lateral segment. According to the pre-operative volumetry, the GV/SLV ratio was 102.5%. As the patient's PV was narrow, sclerotic and thick, we decided to put an interposition with the IMV graft of the donor between the confluence and the graft PV. The graft PV was anastomosed to the IMV graft. The warm ischemic time was 34 min, and the cold ischemic time was 82 min. The ratio of the graft size to the recipient weight (G/R ratio) was 4.2%. After reperfusion, we found that the graft had poor perfusion and decided to reduce the graft size. We noted good perfusion in the residual area after the lateral edge was clamped with an intestinal clamp. The liver tissue was sufficiently fractured with an intestinal clamp and then was divided with a linear stapler. The final G/R ratio was 3.6%. The total length of the operation was 12 h and 20 min. The amount of blood lost was 430 mL. No surgical complications, including post-operative hemorrhage and bile leakage, were encountered. We believe that using the linear stapler decreased the duration of the operation and was an acceptable technique for reducing the graft after reperfusion.
authors: Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
authors: Masahiro
authors: M
authors: Zenitani
authors: Takehisa
authors: T
authors: Ueno
authors: Keigo
authors: K
authors: Nara
authors: Kengo
authors: K
authors: Nakahata
authors: Shuichiro
authors: S
authors: Uehara
authors: Hideki
authors: H
authors: Soh
authors: Takaharu
authors: T
authors: Oue
authors: Hiroki
authors: H
authors: Kondo
authors: Hiroaki
authors: H
authors: Nagano
authors: Noriaki
authors: N
authors: Usui
mesh_terms: D001656:Biliary Atresia / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007223:Infant; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D009929:Organ Size; D017792:Surgical Stapling; D020858:Tissue and Organ Harvesting / Q000379:methods*
keywords: liver transplant; living donor; pediatric liver transplantation