SUCCESSFUL USE OF SIZE-MISMATCHED LIVER ALLOGRAFTS IN CHILDREN BY DELAYED PRIMARY CLOSURE OF THE ABDOMINAL-WALL

Children who are too ill to await a liver graft of suitable size may b e transplanted with a relatively oversized graft by leaving the abdomi nal wound partially open, the defect being bridged with polypropylene mesh and the mesh reduced in stages until it can be removed and the wo und directly closed. This technique has been used in seven children wh o received nine grafts (five reduced and four full size), Their mean a ge was 7.3 (range 0.5-11) month sand mean weight 5.8 (range 2.3-7.2)kg . Progressive reduction in the size of the transplanted liver made pri mary closure possible in survivors in up to four stages. Over a follow -up period of 3 to 58 months, five of the nine grafts and five of the seven patients survived. No significant complications attributable to the technique were encountered, The technique of delayed primary abdom inal wall closure may be of benefit in children at risk of graft failu re because of a size-mismatched graft.