Monosegmental Liver Transplantation From an Adult to an Infant

Abstract

A shortage of small pediatric organ donors has led to the development of reduced size liver transplantation in children. However, the discrepancy between donor and recipient weight can limit the use of this procedure despite transplantation of the left lobe only. Monosegmental liver transplantation using segment III only was recently described. We report here the case of an 11 month old, 6.9 kg boy who received another monosegmental graft (segment II) from a 78 kg donor on an urgent basis. Because of the lack of parenchymal landmarks between segments II and III, sterile methylene blue solution was injected into the portal vein of segment III: parenchyma of this segment colored immediately and was resected accordingly. Three and a half years later, the growth, development, and nutrition of this child were normal. This procedure seems to be helpful when the left lobe of the graft is obviously too large.

Delayed primary closure and the incidence of surgical complications in pediatric liver transplant recipients

“…As only 40% of infants undergoing LT are able to have their abdomen closed primarily, DPC has become common practice even in this era of reduced-sized liver grafts [4]. Some studies have indicated that DPC increases the risk of wound complications including wound infection, dehiscence, and incisional hernias [4,21]. Our study refutes these findings.…”

Liver transplantation with monosegments. Technical aspects and outcome: A meta-analysis

“…Nine publications were identified from 1995 to 2004 5–13. A total number of patients from 7 publications were analyzed, because 2 publications from the same institution appeared to represent partial data from other publications by the same team 10, 11.…”

“…To overcome a weight discrepancy of more than 10:1 from donor to recipient, a further reduction of the left lateral segment to a monosegment may be necessary, as has been done with cadaveric5–8 and living related donors (LRD) 9–13. The subsequent reduction could be performed in situ, at the donor operation7, 9, 12 or at the back table procedure,5, 6, 8 with the utilization of the segment II6, 8, 9 or III5, 7, 12, 13 as grafts. The small sample size of reported data from each study on monosegmental liver transplantation (MLT), different donor status (cadaveric or living), and technical reduction of segment II or III make it difficult to draw conclusions about indication and outcome of monosegmental grafts.…”

Living-Donor Liver Transplantation Using Segment 2 Monosegment Graft: A Single-Center Experience

“…The first report of an S2 graft was described by Mentha et al, who used a methylene blue injection to confirm the demarcation line between segments 2 and 3 [11]. When preparing an S2 graft, the left superficial hepatic vein and tributary vein are important when harvesting the graft liver.…”