Advanced preoperative three-dimensional planning decreases the surgical complications of using large-for-size grafts in pediatric living donor liver transplantation

Chen, Cheng‐Yen; Tsou, Yi-Fan; Yeh, Yu-Chen; Tsai, Hung-Pei; Lin, Niang‐Cheng; Liu, Chinsu

doi:10.1016/j.jpedsurg.2022.02.034

Cited by 6 publications

(4 citation statements)

References 18 publications

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“…This suggests its utility in pediatric LT for adolescent recipients as an indicator for graft reduction (Figure 2–4). Of note, in one of the reported cases, we had access to the donor CT scan with volumetric assessment of the donor liver which allowed for better planning of the subsequent graft reduction 20 . We thus advocate the use of D/RW, GRWR, and GW/RAP to guide surgical strategy as described in Figure 4.…”

Section: Discussionmentioning

confidence: 99%

“…Of note, in one of the reported cases, we had access to the donor CT scan with volumetric assessment of the donor liver which allowed for better planning of the subsequent graft reduction. 20 We thus advocate the use of D/RW, GRWR, and GW/RAP to guide surgical strategy as described in Figure 4. In our experience, all adolescent recipients with D/RW <1.5 had a GRWR <3.5% and a GW/RAP <100 which allowed for whole LT. On the other hand, partial liver graft should be considered when D/RW >2.5.…”

Section: Discussionmentioning

confidence: 99%

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Optimizing graft‐recipient size matching in adolescent liver transplantation: Don't forget ex situ right posterior sectionectomy

Rossignol

Muller

Dubois

et al. 2023

Pediatric Transplantation

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Background Graft‐recipient size matching is a major challenge in pediatric liver transplantation, especially for adolescent recipients. Indeed, adolescents have the lowest transplantation rate among pediatric recipients, despite prioritization policies and the use of split grafts. In case of an important graft‐recipient size mismatch, ex situ graft reduction with right posterior sectionectomy (RPS) may optimize the available donor pool to benefit adolescent recipients. Methods We present three cases of liver graft reduction with ex situ RPS for adolescent recipients. The surgical strategy was guided by GRWR (graft/recipient weight ratio), GW/RAP (right anteroposterior distance ratio), and CT‐scan volumetric and anthropometric evaluation. Results Recipients were 12, 13, and 14‐year‐old and weighed 32, 47, and 35 kg, respectively. All liver grafts were procured from brain‐dead donors with a donor/recipient weight ratio >1.5. RPS was performed ex situ, removing 20% of the total liver volume leading to a decrease of the GRWR <4% and the GW/RAP <100 g/cm in each case. All three reduced grafts were successfully transplanted with a static cold storage time ranging from 390 to 510 min without the need for delayed abdominal closure. We did not observe any primary non‐function, vascular complication, or delayed graft function with a median follow‐up of 6 months. One biliary anastomotic stenosis occurred which required surgical treatment. Conclusion Ex situ liver graft reduction with RPS allowed for successful transplantation in case of anthropometric graft‐recipient size mismatch in adolescent liver transplant candidates. Although the use of split grafts remains the gold standard, RPS should be acknowledged as a way to optimize the donor pool, especially for adolescent recipients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Optimizing graft‐recipient size matching in adolescent liver transplantation: Don't forget ex situ right posterior sectionectomy

Rossignol

Muller

Dubois

et al. 2023

Pediatric Transplantation

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show abstract

“…It also allows for superior graft-to-recipient size matching, which can further contribute to optimizing the recipient outcome. [11,12] Historically, the greatest limitation of LDLT has been a concern for donor safety and higher rates of vascular and biliary complications in the recipient when compared with deceased donor pediatric liver transplant. More recent reports demonstrate equivalent rates of such complications in addition to superior recipient survival.…”

mentioning

confidence: 99%

“…This facilitates enhanced preoperative planning for anticipated vascular and biliary anomalies that may require reconstruction in the recipient. It also allows for superior graft-to-recipient size matching, which can further contribute to optimizing the recipient outcome 11,12…”

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confidence: 99%

The current landscape of pediatric living donor liver transplantation in the United States: Benefits, challenges, and future directions

Yoeli

Adams

Pomfret

2023

Clinical Liver Disease

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Graft reduction in adult liver transplantation: indications, techniques, and outcomes

Addeo,

de Mathelin,

Bachellier

2024

Journal of Gastrointestinal Surgery

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Advanced preoperative three-dimensional planning decreases the surgical complications of using large-for-size grafts in pediatric living donor liver transplantation

Cited by 6 publications

References 18 publications

Optimizing graft‐recipient size matching in adolescent liver transplantation: Don't forget ex situ right posterior sectionectomy

Optimizing graft‐recipient size matching in adolescent liver transplantation: Don't forget ex situ right posterior sectionectomy

The current landscape of pediatric living donor liver transplantation in the United States: Benefits, challenges, and future directions

Graft reduction in adult liver transplantation: indications, techniques, and outcomes

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