Implications for the usage of the left lateral liver graft for infants ≤10 kg, irrespective of a large-for-size situation--are monosegmental grafts redundant?

Summary Organ donor shortage for infant liver transplant recipients has lead to an increase in splitting and living donation. For cases in which even transplantation of the left lateral graft(Couinaud’s segments II + III) results in a ‘‘large for size situation’’ with an estimated graftbody weight ratio (GBWR) of >4%, monosegmental liver transplantation was developed. This, however, bears complications because of greater parenchymal surface and suboptimal vascular flow. We exclusively use the left lateral graftfrom living donors or split grafts. Temporary abdominal closure is attempted in cases of increased pressure. We report of 41 pediatric transplants in 38 children £10 kg. Within this group, there were 23 cases with a GBWR of ‡4, and 15 cases with a GBWR <4. There was no statistical difference in vascular or biliary complications. Despite a more frequent rate of temporary abdominal closure, we did not find a higher rate of intra-abdominal infections. Overall, patient and graftsurvival was excellent in both groups (one death, three re-transplants). We noticed, however, that the ventro‐dorsal diameter of the graftappears to be more relevant to potential graftnecrosis than the actual graftsize. In conclusion, the usage of monosegmental graftsseems unnecessary if transplantation of left lateral graftsis performed by an experienced multidisciplinary team, and temporary abdominal closure is favored in cases of increased abdominal pressure.