Dorsal approach plus branch patch technique is the preferred method for liver transplanting small babies with monosegmental grafts

Sanada, Yukihiro; Hishikawa, Shuji; Okada, Noriki; Yamada, Naoya; Katano, Takumi; Hirata, Yuta; Ihara, Yoshiyuki; Urahashi, Taizen; Mizuta, Koichi

doi:10.1007/s00423-016-1479-z

Cited by 3 publications

(10 citation statements)

References 30 publications

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“…Sixteen studies from a pool of sixty-two were selected (6,7,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(23)(24)(25)44) (Figure 1 and Table 1). Six articles (21,22,(26)(27)(28)45) were excluded to avoid repetition as more updated publications from the same institutions were identified.…”

Section: Resultsmentioning

confidence: 99%

“…RLLS. Only three of the ten authors performed the reduction in situ (19,25,44) (6,11,12,16,18,20,23,44). The vast majority were LDLT.…”

Section: Quality Assessmentmentioning

confidence: 99%

“…Several authors (20,23,25) factor on the direct thickness measurement of the graft (median value 6 cm in this SR) or the GRDR (cm from left hepatic vein to PV bifurcation on preop CT imaging) ( 23) to select their surgical strategies. Results, in terms of vascular complications and overall survival, were similar (Table 3).…”

Section: Are the Different Modalities For Surgically Manipulating A Lls Comparable?mentioning

confidence: 99%

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Alternatives to left lateral sector in paediatric liver transplantation—a systematic review on monosegmental and reduced grafts

Gavriilidis¹,

Hidalgo²

2022

Hepatobiliary Surg Nutr

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Importance: In paediatric liver transplantation, excessive graft volume can represent an issue when the graft-recipient-weight-ratio (GRWR) is significantly disproportionate. The traditional left lateral sector (LLS) might too big in small infants and other alternatives are required, such as Monosegmental or Reduced (including Hyper-reduced) grafts. However, replicating the excellent results achieved with full LLS is challenging given (I) the technical complexity generating these modified grafts and (II) the need to overcome the large-for-size scenario in small infants.Objective: An appraisal of the existing experience and results of monosegmental, reduced or hyper-reduced left lateral sector grafts was performed.Data sources: A systematic search of the literature was conducted in Embase, google scholar, Cochrane library, and PubMed.Study selection: Sixteen studies from a pool of sixty-two were selected. Results: After scrutiny of the available literature, sixteen studies were included with 330 patients, transplanted with monosegmental and reduced/hyper-reduced left lateral sectors grafts. There were 10 re-grafts (6 of them <90 days). Overall, median recipient's age and weight were 7 months (5 days-22 months) and 5.8 kg (2.6-8) respectively.Median graft weight was 209 grams and median GRWR was 3.5% (range, 2.7-5.6). 120 out of the 330 pLT were monosegmental (37%) producing a smaller graft (median of 164 grams) and accordingly a lower GRWR (median 3.2%) compared to reduced LLS. Hepatic artery and portal vein thrombosis overall incidence were 1.5% and 4.2%. With a median follow-up of 39 months (range, 6-87), the overall graft and patient survival were 84% (285/340) and 89% (295/330).Conclusions: Monosegmental and Reduced/Hyper-reduced LLS grafts provide access to liver transplantation for very small recipients with excellent results, comparable to the standard LLS.

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Section: Resultsmentioning

confidence: 99%

“…RLLS. Only three of the ten authors performed the reduction in situ (19,25,44) (6,11,12,16,18,20,23,44). The vast majority were LDLT.…”

Section: Quality Assessmentmentioning

confidence: 99%

Section: Are the Different Modalities For Surgically Manipulating A Lls Comparable?mentioning

confidence: 99%

See 1 more Smart Citation

Alternatives to left lateral sector in paediatric liver transplantation—a systematic review on monosegmental and reduced grafts

Gavriilidis¹,

Hidalgo²

2022

Hepatobiliary Surg Nutr

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“…However, our case did not have biliary complications. The problems we experienced in the described case were related to the following: (1) large-for-size graft syndrome[ 4 ]; (2) the transplantable body weight of the recipient; and (3) vessel reconstruction difficulties[ 13 ]. Challenges in managing transplantation for LBWIs with acute liver failure are nearly always due to the low body weight and fragility of the recipient.…”

Section: Discussionmentioning

confidence: 99%

“…Vessel reconstruction in cases similar to the described case is difficult due to the high GRDR between the hepatic vein and the portal vein bifurcation and to diameter mismatch for the hepatic artery between the graft and the recipient[ 13 ]. Hepatic artery reconstruction by the dorsal approach of portal vein anastomosis has been reported to help reduce the risk of hepatic artery complications among small recipients if the GRDR is over 2.4[ 13 ]. At times, the hepatic arteries of such recipients are thin.…”

Section: Discussionmentioning

confidence: 99%

Rescue case of low birth weight infant with acute hepatic failure

Okada

Sanada

Urahashi

et al. 2017

WJG

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We report a case involving a rescued low birth weight infant (LBWI) with acute liver failure. Case: The patient was 1594 g and 323/7 gestational wk at birth. At the age of 11 d, she developed acute liver failure due to gestational alloimmune liver disease. Exchange transfusion and high-dose gamma globulin therapy were initiated, and body weight increased with enteral nutrition. Exchange transfusion was performed a total of 33 times prior to living donor liver transplantation (LDLT). Her liver dysfunction could not be treated by medications alone. At 55 d old and a body weight of 2946 g, she underwent LDLT using an S2 monosegment graft from her mother. Three years have passed with no reports of intellectual disability or liver dysfunction. LBWIs with acute liver failure may be rescued by LDLT after body weight has increased to over 2500 g.

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Successful living donor liver transplantation for liver failure due to maternal T cell engraftment following cord blood transplantation in X-linked severe combined immunodeficiency disease: Case report

Okada

Kawahara

Sanada

et al. 2021

American Journal of Transplantation

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Maternal T cells from perinatal transplacental passage have been identified in up to 40% of patients with severe combined immunodeficiency (SCID). Although engrafted maternal T cells sometimes injure newborn tissue, liver failure due to maternal T cells has not been reported. We rescued a boy with X‐linked SCID who developed liver failure due to engrafted maternal T cell invasion following living donor liver transplantation (LDLT) following unrelated umbilical cord blood transplantation (UCBT). After developing respiratory failure 3 weeks postpartum, he was diagnosed with X‐linked SCID. Pathological findings showed maternal T cells engrafted in his liver and hepatic fibrosis gradually progressed. He underwent UCBT at 6 months, but hepatic function did not recover and liver failure progressed. Therefore, he underwent LDLT using an S2 monosegment graft at age 1.3 years. The patient had a leak at the Roux‐en‐Y anastomosis, which was repaired. Despite occasional episodes of pneumonia and otitis media, he is generally doing well 6 years after LDLT with continued immunosuppression agents. In conclusion, the combination of hematopoietic stem cell transplantation (HSCT) and liver transplantation may be efficacious, and HSCT should precede liver transplantation for children with X‐linked SCID and liver failure.

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Dorsal approach plus branch patch technique is the preferred method for liver transplanting small babies with monosegmental grafts

Cited by 3 publications

References 30 publications

Alternatives to left lateral sector in paediatric liver transplantation—a systematic review on monosegmental and reduced grafts

Alternatives to left lateral sector in paediatric liver transplantation—a systematic review on monosegmental and reduced grafts

Rescue case of low birth weight infant with acute hepatic failure

Successful living donor liver transplantation for liver failure due to maternal T cell engraftment following cord blood transplantation in X-linked severe combined immunodeficiency disease: Case report

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