Reduction of left-lateral segment from living donors for liver transplantation in infants weighing less than 7 kg: Technical aspects and outcome

Abstract

LLS reduction has been frequently used in infants weighing <7 kg. Twenty recipients weighing <7 kg at the time of LDLT, median age 11.0 months and body weight 5.6 kg, were treated with an RLLS (n = 12) or LLS (n = 8) graft. Absolute indication of size reduction was that the estimated GRWR was >4.0%. Even if the preoperative GRWR was <4.0%, the RLLS graft was considered to ensure a size match. A flatfish-type LLS was preferred to a blowfish-type to make an RLLS graft for such a small infantile population. The RLLS recipients had significantly more flatfish-type grafts, while the LLS recipients had more blowfish-type grafts. Primary full-layer wound closure could be performed successfully in all LLS recipients, while in the RLLS group, two patients were forced to have partial skin closure. There were no graft losses related to graft compression. Reducing an LLS is a useful procedure to promote the comfortable accommodation of the graft in an infant weighing <7 kg. Flatfish-type LLS allowed more flexibility to make the suitable volume.

Portal vein reconstruction in pediatric living donor liver transplantation for patients younger than 1 year with biliary atresia

“…Therefore, they could not wait until they had an acceptable body weight to receive sequential LDLT using a left lateral segmental graft because this was reported to be more than 7.0 kg [8]. No hepatic artery, hepatic vein, or biliary complications were observed in this patient population during the follow-up period.…”

Rationale and surgical technique of laparoscopic left lateral sectionectomy using endoscopic staples

“…Although it has a little risk, the stapler technique can result in injury of the arterial branch to segment IV, and result in atropy of segment IV. However, it does not cause any significant morbidity [17]. …”

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

“…However, primary abdominal closure is sometimes difficult, and the use of synthetic mesh or secondary closure may be necessary to avoid graft compression. These procedures may increase the risk of infectious and respiratory complications [2].To prevent these complications, it is necessary to reduce not only the overall volume, but also the thickness of the graft to achieve primary closure of the abdominal wall. To address this issue, the monosegment graft was introduced for small infants, and Segment 3 monosegment grafts (S3 graft) were most commonly used early in the clinical experience with this approach [3e5].…”

“…However, primary abdominal closure is sometimes difficult, and the use of synthetic mesh or secondary closure may be necessary to avoid graft compression. These procedures may increase the risk of infectious and respiratory complications [2].…”