Affiliation:
1. Department of Pediatric Surgery and Liver Transplantation Femme Mere Enfant University Hospital Lyon France
2. Department of General Surgery and Liver Transplantation Croix‐Rousse University Hospital Lyon France
3. The Cancer Research Center of Lyon, INSERM U1052 Lyon France
4. Department of Radiology Croix‐Rousse University Hospital Lyon France
Abstract
AbstractBackgroundGraft‐recipient size matching is a major challenge in pediatric liver transplantation, especially for adolescent recipients. Indeed, adolescents have the lowest transplantation rate among pediatric recipients, despite prioritization policies and the use of split grafts. In case of an important graft‐recipient size mismatch, ex situ graft reduction with right posterior sectionectomy (RPS) may optimize the available donor pool to benefit adolescent recipients.MethodsWe present three cases of liver graft reduction with ex situ RPS for adolescent recipients. The surgical strategy was guided by GRWR (graft/recipient weight ratio), GW/RAP (right anteroposterior distance ratio), and CT‐scan volumetric and anthropometric evaluation.ResultsRecipients were 12, 13, and 14‐year‐old and weighed 32, 47, and 35 kg, respectively. All liver grafts were procured from brain‐dead donors with a donor/recipient weight ratio >1.5. RPS was performed ex situ, removing 20% of the total liver volume leading to a decrease of the GRWR <4% and the GW/RAP <100 g/cm in each case. All three reduced grafts were successfully transplanted with a static cold storage time ranging from 390 to 510 min without the need for delayed abdominal closure. We did not observe any primary non‐function, vascular complication, or delayed graft function with a median follow‐up of 6 months. One biliary anastomotic stenosis occurred which required surgical treatment.ConclusionEx situ liver graft reduction with RPS allowed for successful transplantation in case of anthropometric graft‐recipient size mismatch in adolescent liver transplant candidates. Although the use of split grafts remains the gold standard, RPS should be acknowledged as a way to optimize the donor pool, especially for adolescent recipients.
Subject
Transplantation,Pediatrics, Perinatology and Child Health
Cited by
1 articles.
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