INNOVATIVE TECHNIQUES IN PEDIATRIC LIVER-TRANSPLANTATION - REDUCED-LIVER-TRANSPLANTATION, SPLIT-LIVER-TRANSPLANTATION AND LIVING-DONOR RELATED LIVER-TRANSPLANTATION

In spite of the increased number of organ donations, the amount of liv ers available for pediatric patients does not meet requirements. In an attempt to expand the pool of grafts, several techniques of size redu ction (RST) have been developed: reduced-liver transplantation (RLT), liver segment transplantation (LST), ''split'' liver transplantat (SLT ) and living-donor liver transplantation (LDLT). The aim of this work is to study the contribution of these techniques to reduction of morta lity in the waiting list and the increased risks that we inflict to ou r patients by using these procedures. We report our experience of RST in the last nine years (23 RLT, 5 LST, 2 SLT and 3 LDLT). More than a half of them were performed in an emergency. Overall survival in child ren with RST (67%) is similar to that of patients receiving a ''whole graft'' (74%). We did not find significant differences in the incidenc e of graft-related complications, only reintervention for abdominal bl eeding was needed more often in the RST group (30%) than in whole graf t group (24%). Our data confirm the safety of the RST procedures in th e pediatric liver transplantation programs and they decrease the waiti ng-list mortality (2.5%) among the pediatric patients.