Surg Gynecol Obstet 1990 Aug;171(2):139-47

Experience with reduced-size liver transplantation

Kalayoglu M, D'Alessandro AM, Sollinger HW, Hoffman RM, Pirsch JD, Belzer FO

Abstract
Orthotopic liver transplantation with reduced-size liver transplants (RLT) has
been proposed as a way of alleviating the limited availability of size-matched
donor organs for pediatric recipients. The use of RLT should increase the pool
of available donors and decrease the number of pediatric patients who die while
awaiting a full-size hepatic graft. Between May 1988 and April 1989, 15 RLT were
placed in 12 patients. Twelve were left lobe and three were extended right lobe
grafts. The mean donor to recipient ratio was 9.0:1.0 (range of 3.3:1.0 to
19.9:1.0). Graft complications occurred in four RLT, and extrahepatic
complications occurred in five patients. Preservation of grafts with University
of Wisconsin solution was used in all instances, with a mean preservation time
of 14.1 hours (range of 8.5 to 19.5 hours). Retransplantation with RLT was
successful in three of four patients. The actual patient survival rate was 83
per cent after a mean follow-up interval of 6.7 months (range of one to 11
months). Our experience indicates that patient survival with RLT is comparable
with full-size grafting and should be offered as an acceptable method of therapy
for end-stage liver disease in pediatric patients. The application of RLT
techniques in a more elective setting may yield further improvements in patient
survival