title: Selection of living donor liver grafts for patients weighing 6kg or less.
abstract: In the field of pediatric living donor liver transplantation (LDLT), physicians sometimes must reduce the volume of left lateral segment (LLS) grafts to prevent large-for-size syndrome. There are 2 established methods for decreasing the size of an LLS graft: the use of a segment 2 (S2) monosegment graft and the use of a reduced LLS graft. However, no procedure for selecting the proper graft type has been established. In this study, we conducted a retrospective investigation of LDLT and examined the strategy of graft selection for patients weighing ≤6 kg. LDLT was conducted 225 times between May 2001 and December 2012, and 15 of the procedures were performed in patients weighing ≤6 kg. We selected S2 monosegment grafts and reduced LLS grafts if the preoperative computed tomography (CT)-volumetry value of the LLS graft was >5% and 4% to 5% of the graft/recipient weight ratio, respectively. We used LLS grafts in 7 recipients, S2 monosegment grafts in 4 recipients, reduced S2 monosegment grafts in 3 recipients, and a reduced LLS graft in 1 recipient. The reduction rate of S2 monosegment grafts for use as LLS grafts was 48.3%. The overall recipient and graft survival rates were both 93.3%, and 1 patient died of a brain hemorrhage. Major surgical complications included hepatic artery thrombosis in 2 recipients, bilioenteric anastomotic strictures in 2 recipients, and portal vein thrombosis in 1 recipient. In conclusion, our graft selection strategy based on preoperative CT-volumetry is highly useful in patients weighing ≤6 kg. S2 monosegment grafts are effective and safe in very small infants particularly neonates.
authors.affiliation: Department of Transplant Surgery, Tochigi, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Yamada
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Sanada
authors.forename: Yuta
authors.initials: Y
authors.lastname: Hirata
authors.forename: Noriki
authors.initials: N
authors.lastname: Okada
authors.forename: Taiichi
authors.initials: T
authors.lastname: Wakiya
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ihara
authors.forename: Atsushi
authors.initials: A
authors.lastname: Miki
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kaneda
authors.forename: Hideki
authors.initials: H
authors.lastname: Sasanuma
authors.forename: Taizen
authors.initials: T
authors.lastname: Urahashi
authors.forename: Yasunaru
authors.initials: Y
authors.lastname: Sakuma
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Yasuda
authors.forename: Koichi
authors.initials: K
authors.lastname: Mizuta
mesh_terms: D000293:Adolescent; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D005260:Female; D006499:Hepatic Artery / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D018579:Patient Selection; D011169:Portal Vein / Q000503:physiopathology; D057234:Preoperative Period; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology; D055815:Young Adult