Living-Donor Liver Transplantation Using Segment 2 Monosegment Graft: A Single-Center Experience.
BACKGROUND
In small infants, left lateral segment grafts are sometimes too large to overcome the problems of large-for-size grafts in the abdominal compartment. To address this problem, we have developed a safe living donor graftectomy for neonates, a so-called "S2 monosegment graft" to minimize graft thickness. We reviewed our single-center experience to evaluate the feasibility of this technique for reducing graft size.


METHODS
Eleven living-donor liver transplants using S2 monosegment grafts were performed between October 2008 and September 2014 at our institution. Medical records of both donors and recipients were reviewed and data collected retrospectively.


RESULTS
The mean age of recipients at the time of transplantation was 125.3 days, including 3 neonates. The average S2 monosegment graft weight was 127.4 g, and the graft-to-recipient body weight ratio was successfully reduced to 3.5%. The graft livers were reduced to 4.1 cm in thickness. Two recipients with grafts larger than 5 cm could not undergo primary abdominal closure. Portal vein stenosis and biliary stenosis was observed in 1 recipient, and hepatic artery complications were seen in 2 recipients; the clinical course for all donors were uneventful. Liver regeneration was seen in every patient. The graft and patient 1-year survival rate was 100%.


CONCLUSIONS
Living-donor liver transplantation using S2 monosegment grafts offers a safe and useful option for treating smaller infants. Here, we introduce our method of S2 monosegment graft emphasizing the donor harvest and graft thickness.
Department of Surgery, Jichi Medical University, Tochigi, Japan. Electronic address: naruchan@jichi.ac.jp.
Y
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Sakuma
Department of Surgery, Jichi Medical University, Tochigi, Japan.
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Sasanuma
Department of Surgery, Jichi Medical University, Tochigi, Japan.
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Miki
Department of Surgery, Jichi Medical University, Tochigi, Japan.
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Shimizu
Department of Surgery, Jichi Medical University, Tochigi, Japan.
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Sata
Department of Surgery, Jichi Medical University, Tochigi, Japan.
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Yasuda
Department of Surgery, Jichi Medical University, Tochigi, Japan.
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Lefor
Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
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Hirata
Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
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Yamada
Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
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Okada
Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
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Y
Sanada
Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
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Ihara
Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
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Urahashi
Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
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Mizuta
D000328:Adult; D046148:Donor Selection; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017093:Liver Failure / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D061646:Operative Time; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome