Arch Surg 1991 Oct;126(10):1278-85; discussion 1285-6

The impact of liver reductions in pediatric liver transplantation

Esquivel CO, Nakazato P, Cox K, Concepcion W, Berquist W, Russell TR

Abstract
Reduced-size liver transplantation (RSLT) in children was introduced to
alleviate a shortage of small-organ donors. The impact of RSLT on the waiting
time for an organ and on morbidity and mortality was investigated. Between March
25, 1988, and August 11, 1990, 61 hepatic transplantations were performed in 55
children at the Pacific Transplant Institute in San Francisco, Calif. Full-size
liver transplantation was performed in 41 cases and RSLT in 20 cases. The
overall 30-month actuarial patient and graft survival rates were 89% and 73%,
respectively. A comparison between full-size liver transplantation and RSLT
showed no difference in patient and graft survival, reoperations, infections, or
rejection. Benefits of RSLT were an increase in the donor pool size, a decrease
in waiting time for a suitable donor, and a decrease in the rate of arterial
thrombosis. The main morbidity of RSLT was an increase in perioperative blood
requirement. We conclude that RSLT offers small children with end-stage liver
disease a chance for long-term survival