Abstract
There are two causes of graft compression in the large-for-size syndrome (LFSS). One is a shortage of intra-abdominal space for the liver graft, and the other is the size discrepancy between the anteroposterior dimensions of the liver graft and the lower right hemithorax of the recipient. The former could be treated using delayed fascial closure or mesh closure, but the latter may only be treated by reduction of the right liver graft to increase space. Given that split liver transplantation has strict requirements regarding donor and recipient selections, reduced-size liver transplantation, in most cases, may be the only solution. However, surgical strategies for the reduction of the right liver graft for adult liver transplantations are relatively unfamiliar. Herein, we introduce a novel strategy of HuaXi-ex vivo right posterior sectionectomy while preserving the right hepatic vein in the graft to prevent LFSS and propose its initial indications.
Highlights
Large-for-size syndrome (LFSS) usually occurs in paediatric liver transplantation (LT) due to the implantation of an excessively large liver graft into a small recipient cavity, resulting in poor graft or recipient outcomes.[1, 2] in recent years, with the increased prevalence of obesity epidemic among the donor pool, the incidence of LFSS tends to increase in adult LTs.[3]. In addition, the present organ-allocation system is mainly based on scores reflecting the severity of liver disease without any consideration of the morphological parameter mismatch between the donor and recipient.[4] transplant surgeons can encounter graft-recipient size mismatch in adult LTs
It took much time to separate the abdominal adhesions for three recipients with recurrent hepatocellular carcinoma (HCC) (Cases 1, 4, and 5) after liver resection
Four formulas have been proposed to predict the occurrence of LFSS.[2, 12,13,14] only one formula introduced an individualised morphological measurement (RAP value) on the recipient.[2]. In the present case series, we selected graft weight (GW)/right anteroposterior (RAP) combined with graft-recipient weight ratio (GRWR) as new “LFSS predictors” for the following reasons
Summary
Large-for-size syndrome (LFSS) usually occurs in paediatric liver transplantation (LT) due to the implantation of an excessively large liver graft into a small recipient cavity, resulting in poor graft or recipient outcomes.[1, 2] in recent years, with the increased prevalence of obesity epidemic among the donor pool, the incidence of LFSS tends to increase in adult LTs.[3]. There are two causes of graft compression in LFSS. One is a shortage of intra-abdominal space for the graft, and the other is the size discrepancy between the anteroposterior dimensions of the graft and the lower right hemithorax of the recipient. The former could be treated using delayed fascial closure or mesh closure; the latter may only be treated by reduction of the right liver graft to increase space. We introduce a novel strategy of ex vivo right posterior sectionectomy (eRPS) while preserving the right hepatic vein (RHV) in the graft to prevent LFSS and propose its initial indications
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