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Korean J Transplant 2020; 34(3): 204-209

Published online September 30, 2020

https://doi.org/10.4285/kjt.2020.34.3.204

© The Korean Society for Transplantation

Pediatric split liver transplantation using a hyperreduced left lateral segment graft in an infant weighing 4 kg

Jung-Man Namgoong1 , Shin Hwang1 , Dae-Yeon Kim1 , Gi-Won Song1 , Chul-Soo Ahn1 , Kyung Mo Kim2 , Seak Hee Oh2

1Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
2Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence to: Shin Hwang
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
Tel: +82-2-3010-3930
Fax: +82-2-3010-6701
E-mail: shwang@amc.seoul.kr

Received: June 15, 2020; Revised: July 8, 2020; Accepted: July 9, 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We present a case of successful split liver transplantation (LT) using a hyperreduced left lateral segment (LLS) graft in a 106-day-old female infant patient weighing 4 kg. The patient was diagnosed with progressive familial intrahepatic cholestasis. Her general condition and liver function deteriorated progressively and she was finally allocated for a split LT under status 1. The deceased donor was a 20-year-old female weighing 63.7 kg. We performed in situ liver splitting and in situ size reduction sequentially. The weight of the hyperreduced LLS graft was 225 g, with a graft-recipient weight ratio of 5.5%. We performed recipient hepatectomy and graft implantation according to the standard procedures for pediatric living-donor LT. Since the graft was too large for primary abdomen closure, the abdominal wall was closed in three stages to make a prosthetic silo, temporary closure with a xenograft sheet, and final primary repair over 2 weeks. The patient has been doing well for more than 6 years after transplantation. In conclusion, split LT using a hyperreduced LLS graft can be a useful option for treating small infants. However, large-for-size graft-related problems, particularly in terms of graft thickness, still remain to be solved.

Keywords: Infant, Large-for-size graft, Pediatric transplantation, Graft-recipient weight ratio, Left lateral segment

HIGHLIGHTS
  • We present a case of successful split liver transplantation using a hyperreduced left lateral segment graft in a 106-day-old infant patient weighing 4 Kg.