Reduced–Size Orthotopic Liver Transplantation: Use in the Management of Children With Chronic Liver Disease

Open Access
Publisher Website
Google Scholar
Abstract
Reducing the size of a liver for use in a recipient smaller than the donor is one way to reduce mortality before orthotopic liver transplantation in children because of the scarcity of pediatric organ donors. In this report, we review the results of this approach over the past 2 years, during which we have used reduced–size orthotopic liver transplantation routinely in small children. Forty–nine children underwent orthotopic liver transplantation between September, 1986, and October, 1988; orthotopic liver transplantation with a whole organ (full–size orthotopic liver transplantation) was performed in 36 children, whereas 13 patients received reduced–size orthotopic liver transplantation. In two pairs of patients, the reduced grafts were obtained from single donors, using a “split–liver” procedure. All grafts were implanted in the orthotopic position following total recipient hepatectomy. The preoperative diagnostic categories were not significantly different between groups. Patients receiving reduced–size orthotopic liver transplantation were younger (1.6 ± 1.5 vs. 4.4 ± 4.6 years), and a higher percentage were in the intensive care unit prior to transplant (31 vs. 9%). Thirty of 36 (82%) patients receiving full–size orthotopic liver transplantation and 10 of 13 (77%) patients receiving reduced–size orthotopic liver transplantation are alive 3 to 27 months after transplantation. The rates of retransplantation were 24% for full–size orthotopic liver transplantation and 15% for reduced–size orthotopic liver transplantation. Despite the greater complexity of reduced–size ortho–topic liver transplantation and the higher frequency of critically ill recipients selected for the procedure, the results of reduced–size orthotopic liver transplantation are comparable with full–size orthotopic liver transplantation. These results justify the continued use of reduced–size orthotopic liver transplantation in children with end–stage liver disease.