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Pediatric Living Donor Liver Transplantation

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Pediatric Hepatology and Liver Transplantation

Abstract

Living donor liver transplantation (LDLT) was introduced as an alternative procedure to resolve the issue of organ shortage in the setting of deceased donor liver transplantation, and this modality has been expanded from pediatrics to adults. Nowadays, introduction of LDLT in many countries has resulted in low wait-list mortality and good clinical outcomes. There have been technical and immunological refinements in the field of pediatric LDLT, such as resolving graft size mismatching and overcoming blood type mismatches.

According to the evaluation of a living donor candidate, there are some pitfalls related to the specificities of pediatric liver diseases. When LDLT is being considered for pediatric recipients with genetic background, such as Alagille syndrome and inherited metabolic disorders, the genetic predisposition should be ruled out for the donor candidates. The obstacle of blood type mismatches has been overcome since the introduction of rituximab, although ABO-incompatible LDLT for patients aged less than 1.5 years old do not need any preconditioning regimens for B-cell desensitization.

Reduction procedures for adult left lateral segments, including hyper-reduced grafts and monosegmental grafts, have recently been developed to eliminate size mismatch in LDLT for small children. Monosegmental grafts obviously have advantages in that it reduces the graft thickness to avoid the problems related to “large-for-size” grafts. Obtaining sufficient portal venous (PV) front flow is crucial in pediatric LDLT. The collateral vessels, including left gastric vein, splenorenal shunts, and retroperitoneal shunts, must be carefully devascularized, so-called cruise technique. Splenorenal shunt ligation from anterior approach would be effective. If the native PV is sclerotic with insufficient front flow, especially small caliber of the native PV, PV anastomosis by using interpositional vein graft is indicated.

This LDLT chapter is useful in maintaining high-quality surgery in all pediatric patients and in avoiding unrecognized changes in surgical strategy for all involved in this field.

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  1. Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan

    Mureo Kasahara, Seisuke Sakamoto & Akinari Fukuda

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  1. Mureo Kasahara
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Correspondence to Mureo Kasahara .

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  1. Paediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII Bergamo, Bergamo, Italy

    Lorenzo D'Antiga

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Kasahara, M., Sakamoto, S., Fukuda, A. (2019). Pediatric Living Donor Liver Transplantation. In: D'Antiga, L. (eds) Pediatric Hepatology and Liver Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-96400-3_28

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