Aggressive Graft Volume Reduction in Pediatric Living Donor Liver Transplantation under One Year Old Patients. (July 2018)

• Record Type: Journal Article
• Authors: Ueno, Takehisa; Saka, Ryuta; Yamanaka, Hiroaki; Takama, Yuichi; Tazuke, Yuko; Bessho, Kazuhiko; Eguchi, Hidetoshi; Okuyama, Hiroomi
• Is Part Of: Transplantation. Volume 102(2018)Supplement 7S-1
• Publication Date: 2018-07
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/01.tp.0000542568.63831.55
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Introduction: Left lateral segment grafts are generally used for very young pediatric living donor liver transplantation (LDLT), however large-for-size grafts were sometimes seen then resulted in graft loss. The ideal graft volume (GV) is unknown in pre transplant assessment. Recently graft reduction techniques were developed. For example mono segment graft is applied to new born LDLT. We studied relations between estimated GV and actual GV, then assessed reduction techniques under 1-year old patients. Method: The recipients under 1-year old who received LDLT between January 2006 and October 2017 were gathered. All donors of LDLT were their parents. Left lateral lobe or left lobe was resected as a graft from the donor. Graft reduction was performed with hemostat crushing technique on back table. Otherwise it was performed after reperfusion with Cavitron Ultrasonic Surgical Aspirator (CUSA) or linier stapler. Pre transplant standard liver volume (SLV) was estimated with Urata's equation from patients height and body weight (BW). Graft type, graft weight (GW) and native liver weight were assessed. Liver specific gravity was approximated to 1.0 g/ml. Results: Twenty-three patients were gathered. Original diseases were biliary atresia (n=17), fulminant hepatitis (n=5) and progressive familial intrahepatic cholestasis type 2 (n=1). Final graft types were left lobe (n=1), left lateral lobe (n=13), reduced left lateral lobe (n=6), segment 2 mono segment (n=1) and reduced segment 2 mono segment (n=2). Final GW/BW after reduction was median 3.2% (ranged 1.7% to 4.5%). Native liver weight/SLV was median 164% except for fulminant hepatitis. GW/native liver weight was median 53%. Pre reduction GV/estimated GV was median 102% but it was fluctuated between 77% and 186%. Estimated GV/SLV of lateral segment graft that required reduction (n=9) was median 112% (ranged 86% to 154%), final reduced graft GV/SLV was median 86% (ranged 74% to 122%). Complications due to large for size graft was unable closure of abdomen and portal vein thrombosis in one case with GV/SLV 122%. No complication was seen based on graft reduction like bleeding or bile leakage. All reduced grafts worked well. Discussions: Estimated GV in very young patients under 1-year old varied widely, therefore unexpected large for size graft after donor liver resection was sometimes seen. There were room for implant in the cases except for fulminant hepatitis because native livers were enlarged, however smaller graft is better in terms of portal blood supply. Aggressive volume reduction of graft is recommended to avoid complications based on large for size graft. Mono-segment graft can be useful not in over newborn patients. Conclusion: Estimated GV in very young patients under 1-year old varied widely, Aggressive volume reduction of graft including mono segment is recommended.