Living donor liver transplantation with reduced monosegments for neonates and small infants

Background. In pediatric living donor liver transplantation, left lateral segment or monosegmental graft is used to overcome size discrepancies between adult donors and pediatric recipients. For neonates and extremely small infants, however, problems related to large-for-size graft are sometimes encountered even when using such grafts. The reduced monosegmental graft, in which the caudal part of the monosegmental graft is resected, has been introduced to address this problem. Methods. Of 566 children who underwent transplant between June 1990 and September 2004, reduced monosegment living donor liver transplants were used for nine patients (median age, 144 days; median weight, 4.1 kg). This technique was used for infants with estimated graft-to-recipient weight ratio (GRWR) >= 4.0% when using the left lateral segment. Results. Graft and patient survival was 66.7%. GRWR was reduced from 7.45 +/- 2.70% to 3.39 +/- 0.89% using this modification. Transaminase levels at days 1 and 2 after transplantation were significantly higher in reduced monosegmental transplantation than in left lateral segmental transplantation. Hepatic artery thrombosis and portal vein thrombosis were observed in one case each. Conclusion. Reduced monosegmental living donor liver transplantation represents a feasible option for neonates and extremely small infants with liver failure.