title: Two-stage liver transplantation using auxiliary laparoscopically harvested grafts in adults: Emphasizing the concept of "hypersmall graft nursing".
abstract: BACKGROUND
  Living donor liver transplantation is limited by the donor's risk in case of right liver donation and by the risk of small-for-size syndrome on the recipient in case of left lobe transplantation. This study aimed at evaluating the feasibility and results of two-stage liver transplantation using auxiliary hyper small grafts harvested laparoscopically and discussing relevant technical insights and issues that still need to be overcome.
  
  
  METHODS
  Retrospective analysis involving two patients operated at a tertiary referral center. The recipients underwent left lateral sectionectomy and then auxillary liver transplantation using laparoscopically harvested left lateral section. The native right liver was transiently left in place to sustain the initially small functional graft functional during its hypertrophy.
  
  
  RESULTS
  No donor experienced postoperative complication. After 7days, the hypertrophy rate was 112% (105-120). Doppler assessments during the first two postoperative weeks showed progressive portal vein inflow decrease in the right native livers and portal vein inflow increase in the grafts. Liver biopsies on postoperative day 7 showed no lesion of overperfusion. No recipient experienced liver failure or small-for-size syndrome. Second stage hepatectomy of the native liver was undertaken in one patient. In the other patient, biliary stenosis on postoperative day 30 precluded second stage hepatectomy. This patient required retransplantation after one year.
  
  
  CONCLUSIONS
  The current strategy increases donor safety and may allow increasing the pool of available grafts. Refinements in the management of the native right liver are however required to improve the feasibility rate of this strategy.
authors.affiliation: Department of liver transplantation and HPB surgery, hopital Pitié-Salpêtrière, université Paris 6-Pierre-et-Marie-Curie, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France. Electronic address: olivier.scatton@aphp.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Scatton
authors.affiliation: Department of liver transplantation and HPB surgery, hôpital Beaujon, université Paris 7-Xavier-Bichat, Assistance publique-Hôpitaux de Paris, 92110 Clichy, France.
authors.forename: François
authors.initials: F
authors.lastname: Cauchy
authors.affiliation: Department of liver transplantation and HPB surgery, hopital Pitié-Salpêtrière, université Paris 6-Pierre-et-Marie-Curie, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Filomena
authors.initials: F
authors.lastname: Conti
authors.affiliation: Department of liver transplantation and HPB surgery, hopital Pitié-Salpêtrière, université Paris 6-Pierre-et-Marie-Curie, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Fabiano
authors.initials: F
authors.lastname: Perdigao
authors.affiliation: Department of digestive surgery, hôpital Cochin, université Paris 5-René-Descartes, Assistance publique-Hôpitaux de Paris, 75014 Paris, France.
authors.forename: Pierre Philippe
authors.initials: PP
authors.lastname: Massault
authors.affiliation: Department of liver transplantation and HPB surgery, hopital Pitié-Salpêtrière, université Paris 6-Pierre-et-Marie-Curie, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Goumard
authors.affiliation: Department of liver transplantation and HPB surgery, hôpital Beaujon, université Paris 7-Xavier-Bichat, Assistance publique-Hôpitaux de Paris, 92110 Clichy, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Soubrane
mesh_terms: D000328:Adult; D005260:Female; D006085:Graft Survival; D006801:Humans; D010535:Laparoscopy; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods*