These authors contributed equally to this publication.
Implications for the usage of the left lateral liver graft for infants ≤10 kg, irrespective of a large-for-size situation – are monosegmental grafts redundant?
Article first published online: 7 JUN 2011
© 2011 The Authors. Transplant International © 2011 European Society for Organ Transplantation
Volume 24, Issue 8, pages 797–804, August 2011
How to Cite
Schulze, M., Dresske, B., Deinzer, J., Braun, F., Kohl, M., Schulz-Jürgensen, S., Borggrefe, J., Burdelski, M. and Bröring, D. C. (2011), Implications for the usage of the left lateral liver graft for infants ≤10 kg, irrespective of a large-for-size situation – are monosegmental grafts redundant?. Transplant International, 24: 797–804. doi: 10.1111/j.1432-2277.2011.01277.x
Conflicts of Interest There are no conflicts of interest.
- Issue published online: 5 JUL 2011
- Article first published online: 7 JUN 2011
- Received: 6 January 2011 Revision requested: 7 February 2011 Accepted: 1 May 2011 Published online: 7 June 2011
- biliary complications;
- graft body weight ratio;
- intraoperative ultrasound;
- temporary abdominal closure
Organ donor shortage for infant liver transplant recipients has lead to an increase in splitting and living donation. For cases in which even transplantation of the left lateral graft (Couinaud’s segments II + III) results in a “large for size situation” with an estimated graft body weight ratio (GBWR) of >4%, monosegmental liver transplantation was developed. This, however, bears complications because of greater parenchymal surface and suboptimal vascular flow. We exclusively use the left lateral graft from living donors or split grafts. Temporary abdominal closure is attempted in cases of increased pressure. We report of 41 pediatric transplants in 38 children ≤10 kg. Within this group, there were 23 cases with a GBWR of ≥4, and 15 cases with a GBWR <4. There was no statistical difference in vascular or biliary complications. Despite a more frequent rate of temporary abdominal closure, we did not find a higher rate of intra-abdominal infections. Overall, patient and graft survival was excellent in both groups (one death, three re-transplants). We noticed, however, that the ventro–dorsal diameter of the graft appears to be more relevant to potential graft necrosis than the actual graft size. In conclusion, the usage of monosegmental grafts seems unnecessary if transplantation of left lateral grafts is performed by an experienced multidisciplinary team, and temporary abdominal closure is favored in cases of increased abdominal pressure.