Surgery 1992 May;111(5):532-42

Orthotopic liver transplantation with a reduced-size graft: an ideal compromis
in pediatrics? 

Houssin D, Soubrane O, Boillot O, Dousset B, Ozier Y, Devictor D, Bernard O,
Chapuis Y
Department of Surgery, Cochin University Hospital, Paris, France.
Abstract
This study retrospectively reviewed the results of 81 orthotopic liver
transplantations in 72 pediatric patients with either a full-size graft (n = 41)
or a reduced-size graft (n = 40) during a 4-year period. Two types of liver
reduction were used to obtain a left lobe graft (n = 30) or a left lateral
segment graft (n = 10). The choice of the reduction technique was based on two
criteria: the donor/recipient body weight ratio and the transverse size of the
recipient's abdomen. The patients who underwent transplantation with a
reduced-size graft were younger and smaller than those who received a full-size
graft. The mortality rate of the candidates on the pediatric transplantation
waiting list was 2.7% during the same period. The 3-year survival rate after
elective transplantation was 85% and 75% in the full-size graft group and the
reduced-size graft group, respectively (difference not significant). The use of
reduced-size grafts was associated with higher amounts of red cell and
fresh-frozen plasma transfusions after graft revascularization. The incidence of
postoperative bleeding and bile leakage from the transected surface was low,
whereas hepatic artery and biliary complications were less frequent in the
reduced-size graft group than in the full-size graft group. At the time of
follow-up, liver biochemical test results and quality of life were not different
between the two groups. Despite the constraining technique and the increase in
intraoperative blood loss, orthotopic liver transplantation with a reduced-size
graft allows us to overcome the shortage of pediatric donors and improve the
overall survival rate of children with end-stage liver disease