Impact of graft thickness reduction of left lateral segment on outcomes following pediatric living donor liver transplantation |
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| Authors: | Toshihiro Kitajima Seisuke Sakamoto Kengo Sasaki Soichi Narumoto Kourosh Kazemi Yoshihiro Hirata Akinari Fukuda Rumi Imai Osamu Miyazaki Rie Irie Satoshi Teramukai Shinji Uemoto Mureo Kasahara |
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| Affiliation: | 1. Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan;2. Division of Hepato‐Biliary‐Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan;3. Department of Organ Transplantation, Shiraz University of Medical Sciences, Namazi Hospital, Shiraz, Iran;4. Department of Radiology, National Center for Child Health and Development, Tokyo, Japan;5. Department of Pathology, National Center for Child Health and Development, Tokyo, Japan;6. Department of Biostatistics, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan |
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| Abstract: | Reducing graft thickness is essential to prevent large‐for‐size graft problems in pediatric living donor liver transplantation (LDLT). However, long‐term outcomes of LDLT using reduced‐thickness left lateral segment (LLS) grafts are unclear. In 89 patients who underwent LDLT using reduced LLS grafts between 2005 and 2017, short‐term and long‐term outcomes were compared between a nonanatomically reduced LLS (NAR‐LLS) graft group and a reduced‐thickness LLS graft group. Estimated blood loss was lower and abdominal skin closure was less needed in the recipient operation in the reduced‐thickness LLS graft group. Postoperatively, portal vein (PV) flow was significantly decreased in the NAR‐LLS graft group, and there was shorter intensive care unit (ICU) stay and fewer postoperative complications, especially bacteremia, in the reduced‐thickness LLS graft group. Graft survival at 1 and 3 years after LDLT using reduced‐thickness LLS grafts was 95.2% and 92.4%, respectively, which was significantly better than for NAR‐LLS grafts. Multivariate analysis revealed that fulminant liver failure, hepatofugal PV flow before LDLT, and NAR‐LLS graft were associated with poor graft survival. In conclusion, LDLT using reduced‐thickness LLS grafts is a safe and feasible option with better short‐ and long‐term outcomes in comparison with NAR‐LLS grafts. |
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| Keywords: | clinical research/practice graft survival liver transplantation/hepatology liver transplantation: living donor patient survival |
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