Experience with reduced-size liver transplantation

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.