Monosegment liver transplantation in small infants

Background: Living Donor Liver Transplantation (LDLT) in pediatric patients is an option to address organ shortage and diminish waitlist mortality. Small infants cannot house the entire left lateral segment (LLS) because of large for size syndrome, and abdominal wall compression may jeopardize outcomes. Sometimes, further graft reduction is required. Aim: To report outcomes of 7 liver transplants performed in our Unit 2017–2022, using monosegment left two (MLT) reduction techniques. Patients and Methods: We retrospectively reviewed digital charts of donors and recipients of MLT from our Unit 2017–2022. We analyzed surgical techniques, donors and recipients’ outcomes. Results: From 2001 to 2022, we performed 256 pediatric liver transplantation (LT). Since February 2017 (first MLT), 7 patients have received this technique transplantation until 2022. Average age at LT: 191.4 days (r 20–720 d), 2 were newborn. Average weight: 5614 gr (r 2500–9600 gr). In our series, there were no Hepatic Artery Thrombosis. Two patients showed portal vein stenosis at the distant post-transplant period. Graft and patient one-year survival rate: 85.7 % and 71 % at three years. Two patients passed away 8 and 14 months post-transplant (1 abdominal sepsis from cholangitis, during follow-up outside our country; the other, sepsis from a pneumonia, with normally functioning graft). Average follow-up time: 23.8 months (r 13–46 mo). Donors post-surgical outcome was uneventfully. Conclusions: Related LDLT and MLT reduction offer a safe and useful option for treating small and very small babies.