Pediatric living donor liver transplantation with large‐for‐size left lateral segment grafts

• Published in: American journal of transplantation Vol. 20; no. 2; pp. 504 - 512
• Main Authors: Goldaracena, Nicolas, Echeverri, Juan, Kehar, Mohit, DeAngelis, Maria, Jones, Nicola, Ling, Simon, Kamath, Binita M., Avitzur, Yaron, Ng, Vicky L., Cattral, Mark S., Grant, David R., Ghanekar, Anand
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01.02.2020
• Subjects: Abdomen; Child; Child, Preschool; clinical research/practice; End Stage Liver Disease - mortality; End Stage Liver Disease - surgery; Fascia; Female; Graft Survival; Hepatic artery; Humans; Infant; Liver - anatomy & histology; Liver transplantation; Liver Transplantation - methods; liver transplantation/hepatology; liver transplantation: living donor; Liver transplants; Living Donors; Male; organ allocation; organ procurement and allocation; Organ Size; Patients; Pediatrics; Portal vein; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Retrospective Studies; Risk Factors; Survival; Thrombosis; Treatment Outcome; liver transplantation: living donor; organ allocation; liver transplantation/hepatology; clinical research/practice; organ procurement and allocation; pediatrics
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.15609

Usage of “large‐for‐size” left lateral segment (LLS) liver grafts in children with high graft to recipient weight ratio (GRWR) is controversial due to concerns about increased recipient complications. During the study period, 77 pediatric living donor liver transplantations (LDLTs) with LLS grafts were performed. We compared recipients with GRWR ≥2.5% (GR‐High = 50) vs GRWR <2.5% (GR‐Low = 27). Median age was higher in the GR‐Low group (40 vs 8 months, P> .0001). Graft (GR‐High: 98%, 98%, 98% vs GR‐Low: 96%, 93%, 93%) and patient (GR‐High: 98%, 98%, 98% vs GR‐Low: 100%, 96%, 96%) survival at 1, 3, and 5 years was similar between groups (P = NS). Overall complications were also similar (34% vs 30%; P = .8). Hepatic artery and portal vein thrombosis following transplantation was not different (P = NS). Delayed abdominal fascia closure was more common in GR‐High patients (17 vs 1; P = .002). Subgroup analysis comparing recipients with GRWR ≥4% (GR‐XL = 20) to GRWR <2.5% (GRWR‐Low = 27) revealed that delayed abdominal fascia closure was more common in the GR‐XL group, but postoperative complications and graft and patient survival were similar. We conclude that pediatric LDLT with large‐for‐size LLS grafts is associated with excellent clinical outcomes. There is an increased need for delayed abdominal closure with no compromise of long‐term outcomes. The use of high GRWR expands the donor pool and improves timely access to the benefits of transplantation without extra risks. The use of large‐for‐size left lateral segment grafts in pediatric living donor liver transplantation with potential delayed abdominal wall closure offers a safe and effective option to mitigate organ shortage.