Ann Hepatobiliary Pancreat Surg.  2021 Aug;25(3):414-418. 10.14701/ahbps.2021.25.3.414.

Dextroplantation of a reduced left lateral section graft in an infant undergoing living donor liver transplantation

• Namgoong JM
• Hwang S
• Park GC
• Kim KM
• Oh SH
• Kwon H
• Kwon YJ

• KMID: 2519301
• DOI: http://doi.org/10.14701/ahbps.2021.25.3.414

Abstract

Graft size matching is essential for successful liver transplantation in infant recipients. We present our technique of graft dextroplantation used in an infant who underwent living donor liver transplantation (LDLT) using a reduced left lateral section (LLS) graft. The patient was an 11-month-old female infant weighing 7.8 kg with hepatoblastoma. She was partially responsive to systemic chemotherapy. Thus, LDLT was performed to treat the tumor. The living donor was a 34-year-old mother of the patient. After non-anatomical size reduction, the weight of the reduced LLS graft was 235 g, with a graft-to-recipient weight ratio of 3.0%. Recipient hepatectomy was performed according to the standard procedures of pediatric LDLT. At the beginning of graft implantation, the graft was temporarily placed at the abdomen to determine the implantation location. The graft portal vein was anastomosed with an interposed external iliac vein homograft. As the liver graft was not too large and it was partially accommodated in the right subphrenic fossa, thus the abdominal wall wound was primarily closed. The patient recovered uneventfully. An imaging study revealed deep accommodation of the graft within the right subphrenic fossa. The patient has been doing well for six months without any vascular complications. This case suggests that dextroplantation of a reduced LLS graft can be a useful technical option for LDLT in infant patients.

Keyword

Infant; Large-for-size graft; Pediatric transplantation; Graft-recipient weight ratio; Left lateral segment

Figure

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  Fig. 1 Pretransplant computed tomography findings of the recipient. At five months before the liver transplantation operation, huge multiple tumors occupied the whole liver. (A, B) The abdomen was distended by the enlarged liver. (C, D) At one month before liver transplantation, the tumor size was markedly regressed.

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  Fig. 2 Pretransplant computed tomography findings of the donor. (A) The left lateral section looked like a flat fish. (B) The anatomy of the left hepatic vein is visualized to design the extent of non-anatomical size reduction. Dotted lines indicate the territory of the reduced left lateral section graft.

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  Fig. 3 Intraoperative photographs showing dextroplantation of the reduced left lateral section graft. (A) The portal vein is reconstructed with the interposed vein homograft. (B) The flat lateral part of the graft was resected and a small medial portion of segment III was removed. (C) The graft is partially accommodated in the right subphrenic fossa.

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  Fig. 4 Gross photograph of the explanted liver. There are multiple viable tumors with extensive necrosis.

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  Fig. 5 Posttransplant computed tomography findings taken at four days after the transplantation. (A, C) The reduced left lateral graft is deeply located at the right subphrenic fossa. (B, D) It looks like a usual right liver graft. The elongated interposed portal vein is visualized (arrow). No vascular complication is identified.

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