Living-Donor Liver Transplantation Using Segment 2 Monosegment Graft: A Single-Center Experience

• We described our safe-living donor graftectomy for neonates which involves modifying the previous S2 monosegment grafts.
• For small infants with narrow abdominal cavities, we tried to make as thin graft as possible to achieve primary abdominal closure without graft compression.
• The intraoperative use of sonography with Sonazoid helps to ensure a safe and secure graftectomy.

BackgroundIn small infants, left lateral segment grafts are sometimes too large to overcome the problems of large-for-size grafts in the abdominal compartment. To address this problem, we have developed a safe living donor graftectomy for neonates, a so-called “S2 monosegment graft” to minimize graft thickness. We reviewed our single-center experience to evaluate the feasibility of this technique for reducing graft size.MethodsEleven living-donor liver transplants using S2 monosegment grafts were performed between October 2008 and September 2014 at our institution. Medical records of both donors and recipients were reviewed and data collected retrospectively.ResultsThe mean age of recipients at the time of transplantation was 125.3 days, including 3 neonates. The average S2 monosegment graft weight was 127.4 g, and the graft-to-recipient body weight ratio was successfully reduced to 3.5%. The graft livers were reduced to 4.1 cm in thickness. Two recipients with grafts larger than 5 cm could not undergo primary abdominal closure. Portal vein stenosis and biliary stenosis was observed in 1 recipient, and hepatic artery complications were seen in 2 recipients; the clinical course for all donors were uneventful. Liver regeneration was seen in every patient. The graft and patient 1-year survival rate was 100%.ConclusionsLiving-donor liver transplantation using S2 monosegment grafts offers a safe and useful option for treating smaller infants. Here, we introduce our method of S2 monosegment graft emphasizing the donor harvest and graft thickness.