title: The outcomes of pediatric living donor liver transplantation using small-for-size grafts: experience of a single institute.
abstract: OBJECTIVE
  We aimed to evaluate patients who had undergone pediatric LDLT with small-for-size graft (SFSG) and identify risk factors of graft failure to establish a preoperative graft selection strategy.
  
  
  METHODS
  The data was collected retrospectively. SFSG was used in 14LDLTs (5.7%) of 245 LDLTs performed between May 2001 and March 2014. The mean patient age and body weight at LDLT were 12.6 ± 2.0 years and 40.5 ± 9.9 kg, respectively. The graft type was left lobe in six patients, left + caudate lobe in seven patients, and posterior segment in one patient.
  
  
  RESULTS
  The graft survival rates in SFSG and non-SFSG groups were 78.9 and 93.1%, respectively (p = 0.045). In the univariate analysis, bleeding volume during LDLT were an independent risk factors for graft failure (p = 0.011). Graft failure was caused by sepsis in all three patients and occurred at a median of 70 postoperative days 70 (range 14-88 days). Among them, two cases showed high preoperative PELD/MELD score (PELD; 19.4 and MELD; 22, respectively).
  
  
  CONCLUSIONS
  Pediatric LDLT using SFSG had poor outcome and prognosis, especially when it accompanies the surgical infectious complications with preoperative high PELD/MELD scores.
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. yn708@jichi.ac.jp.
authors.forename: Naoya
authors.initials: N
authors.lastname: Yamada
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Sanada
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Hirata
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Noriki
authors.initials: N
authors.lastname: Okada
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ihara
authors.affiliation: Department of Surgery, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Sasanuma
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Taizen
authors.initials: T
authors.lastname: Urahashi
authors.affiliation: Department of Surgery, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Yasunaru
authors.initials: Y
authors.lastname: Sakuma
authors.affiliation: Department of Surgery, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Yasuda
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Mizuta
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006085:Graft Survival; D006801:Humans; D008099:Liver / Q000033:anatomy & histology* / Q000601:surgery*; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D009929:Organ Size; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Model for end-stage liver disease score; Pediatric living-donor liver transplantation; Portal flow modulation; Predictive graft CT-volumetry; Small-for-size graft