Liver transplantation with monosegments

Background. Shortage of size-matched pediatric donors led to the developmen t of surgical techniques to reduce or split livers and thus increase the po tential pool of donors. Despite this, neonatal transplantation remains a pr oblem because of the small size of the recipients. Further reduction of the left lateral segment is possible to provide a single segment graft (segmen t III). We report our experience of transplanting 6 babies using this techn ique. Methods. Of 310 children transplanted in our center between October 1989 an d March 1998, 6 patients, 2 male and 4 female, median age 37.5 days (range 5 to 92 days), median weight 3.45 kg (range 2.45 to 5.46 kg) were transplan ted with a monosegment. The cause of liver failure was neonatal hemochromat osis in 4, retransplantation for hepatic artery thrombosis in 1, and hepati tis B in one. The donor liver was reduced or split to a left lateral segmen t. Segment II was then resected and discarded before transplantation. Results. Overall, graft and patient survival is 83.3 %. Five patients are a live with good graft function at a mean follow-up of 30.4 months (range 8 t o 82 months). One child who was transplanted for hepatic artery thrombosis died from sepsis and multiorgan failure 48 hrs after transplant. None of th e survivors had vascular or biliary complications. Conclusions. Monosegment liver transplantation with segment III appears to be a satisfactory option for treating small babies with liver failure.