3D-reconstruction and heterotopic implantation of reduced si
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Monosegmental grafts and reduced left lateral segment grafts have been introduced to overcome the problems of large-for-size grafts in pediatric living donor liver transplantation. Researchers introduce a new method of reduced size monosegment or left lateral segment grafts transplanted in the right diaphragmatic fossa heterotopically in small infants.

There were 4 infants who underwent living donor liver transplantation with heterotopically implanted reduced monosegmental or left lateral segment grafts. The demographic, operative, postoperative, and follow-up data of these infants were collected from our prospectively designed database and reviewed. Technical details of the donor and recipient operation are shared and a supplemental provided.

The mean recipient age was 7.5 ± 0.9 months, and body weight was 5.9 ± 0.7 kg. Primary diagnoses of the recipients were biliary atresia and progressive familial intrahepatic cholestasis. The mean graft-recipient weight ratio was 3.3 ± 0.2.

--Reduced monosegment III grafts were used in 2 cases, and reduced left lateral segment grafts were used in the other 2 patients.

--Bile duct reconstruction was done by Roux-en-Y hepaticojejunostomy in 3 patients and duct-to-duct anastomosis in the remaining patient.

--All patients recovered from the liver transplantation operation and are doing well at a mean follow-up of 8 months.

Conclusively, living donor liver transplantation with heterotopically implanted reduced monosegmental or left lateral segment seems feasible for the treatment of neonates and extremely small infants.

Surgery
Source: https://doi.org/10.1016/j.surg.2021.04.015
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