Impact of Medial Reduction of the Left Lateral Segment: A Novel Technique for Living Donor Liver Transplantation for Small Pediatric Recipients

Hirata, Yoshihiro; Agarwal, Shaleen; Varma, Sharat; Balradja, Inbaraj; Verma, Sapana; Selvakumar, Naganathan; Gupta, Subhash

doi:10.1002/lt.25808

Cited by 7 publications

(18 citation statements)

References 5 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%

“…Primary abdominal wall closure was more likely too. The lines of transection for MSG are clearly different from reducing a graft and hence "off-sets" volume and thickness, the only exception being the Medial Reduction described by Hirata et al (25).…”

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

confidence: 89%

“…The studies evaluated were quite heterogenous, including single case reports (6,11) and large series. Five of the sixteen studies (18,19,24,25,44) represented 82% of the total population (Table 1). In addition, the age ranged from 5 days to 22 months.…”

Section: Discussionmentioning

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%

“…Accordingly, a 5 Kg child receiving a LLS graft, will likely face a GRWR close to 5% (1:1 equivalence between cc and grams). It is well documented that GRWR is a strong predictor of graft survival and the vast majority of reports concur that those grafts exceeding 4% will likely generate a conflict with the abdominal cavity's capacity (4,5,13,(16)(17)(18)(19)(20)(21)25,(36)(37)(38). Hence, some groups advocate for altering the LLS, reducing or converting it into a monosegment.…”

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%

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

confidence: 89%

Section: Discussionmentioning

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 3 more Smart Citations

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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Reduced Size Liver Grafts in Pediatric Liver Transplantation; Technical Considerations

Kasahara,

Fukuda,

Uchida

et al. 2024

Journal of Clinical and Experimental Hepatology

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Single center experience of 3000 consecutive living donor hepatectomies

Nidoni

Dey

Agarwal

et al. 2022

Journal of Liver Transplantation

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Impact of Medial Reduction of the Left Lateral Segment: A Novel Technique for Living Donor Liver Transplantation for Small Pediatric Recipients

Cited by 7 publications

References 5 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

Reduced Size Liver Grafts in Pediatric Liver Transplantation; Technical Considerations

Single center experience of 3000 consecutive living donor hepatectomies

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