Surgery 1999 Jul;126(1):10-2

Liver transplantation with monosegments.

Srinivasan P, Vilca-Melendez H, Muiesan P, Prachalias A, Heaton ND, Rela M

Institute of Liver Studies, Kings College Hospital, London, United Kingdom.

Abstract
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.