Hyperreduced left lateral living donor liver transplant in a 4.5 kg child-A first in Africa.

BACKGROUND: Supply-demand mismatch in solid organ transplantation is particularly pronounced in small children. For liver transplantation, advanced surgical techniques for reducing deceased and living donor grafts allow access to life-saving transplantation. Living donor left lateral segment liver grafts have been successfully transplanted in small children in our center since 2013, the only program providing this service in Sub-Saharan Africa. This type of partial graft remains too large for children below 6 kg body weight and generally requires reduction. METHODS: A left lateral segment graft was reduced in situ from a directed, altruistic living donor to yield a hyperreduced left lateral segment graft. RESULTS: The donor was discharged after 6 days without complications. The recipient suffered no technical surgical complications except for an infected cut-surface biloma and biliary anastomotic stricture and remains well 9 months post-transplant. CONCLUSIONS: We report the first known case in Africa of a hyperreduced left lateral segment, ABO incompatible, living donor liver transplant in a 4,5 kg child with pediatric acute liver failure (PALF).

Paediatric living donor liver transplantation.

Paediatric liver transplantation is a highly effective therapy for children with end-stage liver disease; 1-year survival rates currently exceed 90% and long-term survivors enjoy an almost-normal quality of life. Key to the success of paediatric liver transplantation has been the technical refinement to provide children with suitably sized grafts. Adult-to-paediatric living donor liver transplantation highlights this success and has been instrumental in decreasing waiting list mortality to less than 5%.