BACKGROUND: Shortage of size-matched pediatric donors led to the development of surgical techniques to reduce or split livers and thus increase the potential pool of donors. Despite this, neonatal transplantation remains a problem because of the small size of the recipients. Further reduction of the left lateral segment is possible to provide a single segment graft (segment III). We report our experience of transplanting 6 babies using this technique. METHODS: Of 310 children transplanted in our center between October 1989 and March 1998, 6 patients, 2 male and 4 female, median age 37.5 days (range 5 to 92 days), median weight 3.45 kg (range 2.45 to 5.46 kg) were transplanted with a monosegment. The cause of liver failure was neonatal hemochromatosis in 4, retransplantation for hepatic artery thrombosis in 1, and hepatitis B in one. The donor liver was reduced or split to a left lateral segment. Segment II was then resected and discarded before transplantation. RESULTS: Overall, graft and patient survival is 83.3%. Five patients are alive with good graft function at a mean follow-up of 30.4 months (range 8 to 82 months). One child who was transplanted for hepatic artery thrombosis died from sepsis and multiorgan failure 48 hrs after transplant. None of the survivors had vascular or biliary complications. CONCLUSIONS: Monosegment liver transplantation with segment III appears to be a satisfactory option for treating small babies with liver failure.
BACKGROUND: Shortage of size-matched pediatric donors led to the development of surgical techniques to reduce or split livers and thus increase the potential pool of donors. Despite this, neonatal transplantation remains a problem because of the small size of the recipients. Further reduction of the left lateral segment is possible to provide a single segment graft (segment III). We report our experience of transplanting 6 babies using this technique. METHODS: Of 310 children transplanted in our center between October 1989 and March 1998, 6 patients, 2 male and 4 female, median age 37.5 days (range 5 to 92 days), median weight 3.45 kg (range 2.45 to 5.46 kg) were transplanted with a monosegment. The cause of liver failure was neonatal hemochromatosis in 4, retransplantation for hepatic artery thrombosis in 1, and hepatitis B in one. The donor liver was reduced or split to a left lateral segment. Segment II was then resected and discarded before transplantation. RESULTS: Overall, graft and patient survival is 83.3%. Five patients are alive with good graft function at a mean follow-up of 30.4 months (range 8 to 82 months). One child who was transplanted for hepatic artery thrombosis died from sepsis and multiorgan failure 48 hrs after transplant. None of the survivors had vascular or biliary complications. CONCLUSIONS: Monosegment liver transplantation with segment III appears to be a satisfactory option for treating small babies with liver failure.
Authors: Matteo Cescon; Marco Spada; Michele Colledan; Giuliano Torre; Enzo Andorno; Umberto Valente; Giorgio Rossi; Paolo Reggiani; Umberto Cillo; Umberto Baccarani; Gian Luca Grazi; Giuseppe Tisone; Franco Filipponi; Massimo Rossi; Giuseppe Maria Ettorre; Mauro Salizzoni; Oreste Cuomo; Tullia De Feo; Bruno Gridelli Journal: Ann Surg Date: 2006-11 Impact factor: 12.969
Authors: Shikha S Sundaram; Estella M Alonso; Michael R Narkewicz; Song Zhang; Robert H Squires Journal: J Pediatr Date: 2011-05-31 Impact factor: 4.406
Authors: Victoria Ardiles; Miguel A Ciardullo; Daniel D'Agostino; Juan Pekolj; Francisco J Mattera; Gustavo H Boldrini; Claudio Brandi; Axel F Beskow; Ernesto P Molmenti; Eduardo de Santibañes Journal: Langenbecks Arch Surg Date: 2012-10-24 Impact factor: 3.445