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Surgical Techniques

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Pediatric Hepatology and Liver Transplantation

Abstract

Organ supply for paediatric liver transplantation (LT) has evolved over time from full-size grafts to different types of technical variant grafts. Nowadays, most small children are transplanted with left lateral segment grafts (LLSs) from split liver and living donation. This chapter focuses on deceased donor paediatric LT, particularly on split LT (SLT). Split liver is the division of a deceased donor liver into two transplantable parts, each with an adequate hepatocyte mass and with a suitable arterial and portal inflow together with the corresponding venous and biliary drainage. In paediatric LT, donor selection and, even more, size matching are fundamental topics. Surgical technique of paediatric LT has not evolved that much over the last two decades. Instead, advances in the approach to specific anatomical conditions and awareness of some recipient-related and graft-related peculiarities are still contributing to improved results. From the long-lasting debate about the best kind of graft, it emerges that optimal outcomes may be achieved by developing expertise in using any graft types, so that the appropriate graft can be chosen from time to time according to donor- and recipient-related variables. Occasionally, for infants less than 5–6 kg in weight, a safe size matching may require further graft reduction, delayed abdominal closure or the use of LLSs from small paediatric donors. Finally, auxiliary partial orthotopic LT (APOLT) is the object of a renewed interest and may represent an alternative to standard LT in selected cases of acute liver failure (ALF) and non-cirrhotic metabolic liver diseases (NCMLD).

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References

  1. Herden U, Wischhusen F, Heinemann A, Ganschow R, Grabhorn E, Vettorazzi E, Nashan B, Fischer L. A formula to calculate the standard liver volume in children and its application in pediatric liver transplantation. Transpl Int. 2013;26:1217–24.

    Article  PubMed  Google Scholar 

  2. Feng AC, Fan HL, Chen TW, Hsieh CB. Hepatic hemodynamic changes during liver transplantation: a review. World J Gastroenterol. 2014;20:11131–41.

    Article  PubMed  PubMed Central  Google Scholar 

  3. De Magnee C, Veyckemans F, Pirotte T, Menten R, Dumitriu D, Clapuyt P, Carbonez K, Barrea C, Sluysmans T, Sempoux C, Leclercq I, Zech F, Stephenne X, Reding R. Liver and systemic hemodynamics in children with cirrhosis: impact on the surgical management in pediatric living donor liver transplantation. Liver Transpl. 2017;23:1440–50.

    Article  PubMed  Google Scholar 

  4. Seehofer D, Eurich D, Veltzke-Schlieker W, Neuhaus P. Biliary complications after liver transplantation: old problems and new challenges. Am J Transplant. 2013;13:253–65.

    Article  CAS  PubMed  Google Scholar 

  5. Anderson CD, Turmelle YP, Darcy M, Shepherd RW, Weymann A, Nadler M, Guelker S, Chapman WC, Lowell JA. Biliary strictures in pediatric liver transplant recipients—early diagnosis and treatment results in excellent graft outcomes. Pediatr Transplant. 2010;14:358–63.

    Article  PubMed  Google Scholar 

  6. Rela M, Kaliamoorthy I, Reddy MS. Current status of auxiliary partial orthotopic liver transplantation for acute liver failure. Liver Transpl. 2016;22:1265–74.

    Article  PubMed  Google Scholar 

  7. Reddy MS, Rajalingam R, Rela M. Revisiting APOLT for metabolic liver disease: a new look at an old idea. Transplantation. 2017;101:260–6.

    Article  PubMed  Google Scholar 

  8. Starzl TE, Koep LJ, Schroter GP, Halgrimson CG, Porter KA, Weil R 3rd. Liver replacement for pediatric patients. Pediatrics. 1979;63:825–9.

    CAS  PubMed  Google Scholar 

  9. Bismuth H, Houssin D. Reduced-sized orthotopic liver graft in hepatic transplantation in children. Surgery. 1984;95:367–70.

    CAS  PubMed  Google Scholar 

  10. Starzl TE, Demetris AJ. Liver transplantation. Chicago, IL: Year Book Medical Publisher, Inc.; 1990.

    Google Scholar 

  11. Broelsch CE, Emond JC, Thistlethwaite JR, Rouch DA, Whitington PF, Lichtor JL. Liver transplantation with reduced-size donor organs. Transplantation. 1988;45:519–24.

    Article  CAS  PubMed  Google Scholar 

  12. Emond JC, Whitington PF, Thistlethwaite JR, Alonso EM, Broelsch CE. Reduced-size orthotopic liver transplantation: use in the management of children with chronic liver disease. Hepatology. 1989;10:867–72.

    Article  CAS  PubMed  Google Scholar 

  13. Houssin D, Soubrane O, Boillot O, Dousset B, Ozier Y, Devictor D, Bernard O, Chapuis Y. Orthotopic liver transplantation with a reduced-size graft: an ideal compromise in pediatrics? Surgery. 1992;111:532–42.

    CAS  PubMed  Google Scholar 

  14. Pichlmayr R, Ringe B, Gubernatis G, Hauss J, Bunzendahl H. Transplantation of a donor liver to 2 recipients (splitting transplantation). A new method in the further development of segmental liver transplantation. Langenbecks Arch Chir. 1988;373:127–30.

    Article  CAS  PubMed  Google Scholar 

  15. Strong R, Lynch S, Ong T, Matsunami H, Koido Y, Balderson G. Successful liver transplantation from a living donor to her son. N Engl J Med. 1990;322:1505–7.

    Article  CAS  PubMed  Google Scholar 

  16. Otte JB, de Ville de Goyet J, Alberti D, Balladur P, de Hemptinne B. The concept and technique of the split liver in clinical transplantation. Surgery. 1990;107:605–12.

    CAS  PubMed  Google Scholar 

  17. Emond JC, Whitington PF, Thistlethwaite JR, Cherqui D, Alonso EA, Woodle IS, Vogelbach P, Busse-Henry SM, Zucker AR, Broelsch CE. Transplantation of two patients with one liver. Analysis of a preliminary experience with “split-liver” grafting. Ann Surg. 1990;212:14–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Emond J, Heffron T, Thistlethwaite JR. Innovative approaches to donor scarcity. A critical comparison between split liver and living related liver transplantation. Hepatology. 1991;14:92A.

    Google Scholar 

  19. De Ville de Goyet J. Split liver transplantation in Europe: 1988 to 1993. Transplantation. 1995;59:1371–6.

    Article  PubMed  Google Scholar 

  20. Rogiers X, Malagó M, Habib N, Knoefel WT, Pothmann W, Burdelski M, Meyer-Moldenhauer WH, Broelsch CE. In situ splitting of the liver in the heart-beating cadaveric organ donor for transplantation in two recipients. Transplantation. 1995;59:1081–3.

    Article  CAS  PubMed  Google Scholar 

  21. Rogiers X, Malagó M, Gawad K, Kuhlencordt R, Fröschle G, Sturm E, Sterneck M, Pothmann W, Schulte am Esch J, Burdelski M, Broelsch C. One year experience with extended application and modified techniques of split liver transplantation. Transplantation. 1996;61:1059–61.

    Article  CAS  PubMed  Google Scholar 

  22. Rogiers X, Malagó M, Gawad K, Jauch KW, Olausson M, Knoefel WT, Gundlach M, Bassas A, Fischer L, Sterneck M, Burdelski M, Broelsch CE. In situ splitting of cadaveric livers. The ultimate expansion of a limited donor pool. Ann Surg. 1996;224:331–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Azoulay DF, Astarcioglu I, Bismuth H, Castaing D, Majno P, Adam R, Johann M. Split-liver transplantation, The Paul Brousse policy. Ann Surg. 1996;224:737–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Goss JA, Jersiz H, Shackleton CR, Seu P, Smith CV, Markowitz JS, Farmer DG, Gobrial RM, Markmann JF, Arnaout WS, Imagawa DK, Colquhoun SD, Fraiman MH, McDiarmid SV, Busuttil RW. In situ splitting of the cadaveric liver for transplantation. Transplantation. 1997;64:871–7.

    Article  CAS  PubMed  Google Scholar 

  25. Olausson M, Backman L, Friman S, Mjornstedt L, Krantz M, Broelsch CE, Rogiers X. In situ split liver procedures in cadaver and living related donors. Transplant Proc. 1997;29:3094–5.

    Article  CAS  PubMed  Google Scholar 

  26. Mirza DF, Achilleos O, Pirenne J, Buckels JA, McMaster P, Mayer AD. Encouraging results of split-liver transplantation. Br J Surg. 1998;85:494–7.

    Article  CAS  PubMed  Google Scholar 

  27. Rela M, Vougas V, Muiesan P, Vilca-Melendez H, Smyrniotis V, Gibbs P, Karani J, Williams R, Heaton N. Split liver transplantation: King’s College Hospital experience. Ann Surg. 1998;227:282–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Colledan M, Segalin A, Spada M, Lucianetti A, Corno V, Gridelli B. Liberal policy of split liver for pediatric liver transplantation. A single centre experience. Transpl Int. 2000;13:S131–3.

    Article  PubMed  Google Scholar 

  29. ELTR/ELITA data, Data Analysis Booklet Pediatric patients (kindly provided by Dr. Vincent Karam).

    Google Scholar 

  30. Busuttil RW, Goss JA. Split liver transplantation. Ann Surg. 1999;229:313–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Ghobrial RM, Farmer DG, Amersi F, Busuttil RW. Advances in pediatric liver and intestinal transplantation. Am J Surg. 2000;180:328–34.

    Article  CAS  PubMed  Google Scholar 

  32. Spada M, Riva S, Maggiore G, Cintorino D, Gridelli B. Pediatric liver transplantation. World J Gastroenterol. 2009;15:648–74.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Colledan M. Split liver transplantation: technique and results. Transplant Rev. 2005;19:221–31.

    Article  Google Scholar 

  34. Bismuth H. Surgical anatomy and anatomical surgery of the liver. World J Surg. 1982;6:3–9.

    Article  CAS  PubMed  Google Scholar 

  35. Moussaoui D, Toso C, Nowacka A, McLin VA, Bednarkiewicz M, Andres A, Berney T, Majno P, Wildhaber BE. Early complications after liver transplantation in children and adults: are split grafts equal to each other and equal to whole livers? Pediatr Transplant. 2017;21:e12908.

    Article  Google Scholar 

  36. Bismuth H, Morino M, Castaing D, Gillon MC, Descorps Declere A, Saliba F, Samuel D. Emergency orthotopic liver transplantation in two patients using one donor liver. Br J Surg. 1989;76:722–4.

    Article  CAS  PubMed  Google Scholar 

  37. Colledan M, Andorno E, Valente U, Gridelli B. A new splitting technique for liver grafts. Lancet. 1999;353:1763.

    Article  CAS  PubMed  Google Scholar 

  38. Azoulay D, Castaing D, Adam R, Savier E, Delvart V, Karam V, Ming BY, Dannaoui M, Krissat J, Bismuth H. Split-liver transplantation for two adult recipients: feasibility and long-term outcomes. Ann Surg. 2001;233:565–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Sommacale D, Farges O, Ettorre GM, Lebigot P, Sauvanet A, Marty J, Durand F, Belghiti J. In situ split liver transplantation for two adult recipients. Transplantation. 2000;15:1005–7.

    Article  Google Scholar 

  40. Humar A, Ramcharan T, Sielaff TD, Kandaswamy R, Gruessner RW, Lake JR, Payne WD. Split liver transplantation for two adult recipients: an initial experience. Am J Transplant. 2001;1:366–72.

    Article  CAS  PubMed  Google Scholar 

  41. Zamir G, Olthoff KM, Desai N, Markmann JF, Shaked A. Toward further expansion of the organ pool for adult liver recipients: splitting the cadaveric liver into right and left lobes. Transplantation. 2002;74:1757–61.

    Article  PubMed  Google Scholar 

  42. Hwang S, Lee SG, Park KM, Kim KH, Ahn CS, Moon DB, Ha TY. A case report of split liver transplantation for two adult recipients in Korea. Transplant Proc. 2004;36:2736–40.

    Article  CAS  PubMed  Google Scholar 

  43. Colledan M, Segalin A, Andorno E, Corno V, Lucianetti A, Spada M, Gridelli B. Modified splitting technique for liver transplantation in adult-sized recipients. Technique and preliminary results. Acta Chir Belg. 2000;100:289–91.

    CAS  PubMed  Google Scholar 

  44. Giacomoni A, Lauterio A, Donadon M, De Gasperi A, Belli L, Slim A, Dorobantu B, Mangoni I, De Carlis L. Should we still offer split-liver transplantation for two adult recipients? A retrospective study of our experience. Liver Transpl. 2008;14:999–1006.

    Article  PubMed  Google Scholar 

  45. Zambelli M, Andorno E, De Carlis L, Rossi G, Cillo U, De Feo T, Carobbio A, Giacomoni A, Bottino G, Colledan M. Full-right-full-left split liver transplantation: the retrospective analysis of an early multicenter experience including graft sharing. Am J Transplant. 2012;12:2198–210.

    Article  CAS  PubMed  Google Scholar 

  46. Emond JC, Freeman RB, Renz JF, Yersiz H, Rogiers X, Busuttil RW. Optimizing the use of donated cadaver livers: analysis and policy development to increase the application of spit liver transplantation. Liver Transpl. 2002;8:863–72.

    Article  PubMed  Google Scholar 

  47. Schlitt HJ. Which liver is splittable? In: Rogiers X, Bismuth H, Busuttil RW, Broering DC, Azoulay D, editors. Split liver transplantation. Theoretical and practical aspects. Darmstadt: Steinkopff Verlag; 2002. p. 63.

    Chapter  Google Scholar 

  48. Toso C, Ris F, Mentha G, Oberholzer J, Morel P, Majno P. Potential impact of in situ liver splitting on the number of available grafts. Transplantation. 2002;74:222–6.

    Article  PubMed  Google Scholar 

  49. Cardillo M, De Fazio N, Pedotti P, De Feo T, Fassati LR, Mazzaferro V, Colledan M, Gridelli B, Caccamo L, De Carlis L, Valente U, Andorno E, Cossolini M, Martini C, Antonucci A, Cillo U, Zanus G, Baccarani U, Scalamogna M, NITp Liver Transplantation Working Group. Split and whole liver transplantation outcomes: a comparative cohort study. Liver Transpl. 2006;12:402–10.

    Article  PubMed  Google Scholar 

  50. Lauterio A, Di Sandro S, Concone G, De Carlis R, Giacomoni A, De Carlis L. Current status and perspectives in split liver transplantation. World J Gastroenterol. 2015;21:11003–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Petz W, Spada M, Sonzogni A, Colledan M, Segalin A, Lucianetti A, Bertani A, Guizzetti M, Peloni G, Gridelli B. Pediatric split liver transplantation using elderly donors. Transplant Proc. 2001;33:1361–3.

    Article  CAS  PubMed  Google Scholar 

  52. Fukazawa K, Nishida S, Volsky A, Tzakis AG, Pretto EA. Body surface area index predicts outcome in orthotopic liver transplantation. J Hepatobiliary Pancreat Sci. 2011;18:216–25.

    Article  PubMed  Google Scholar 

  53. Gelas T, Mirza DF, Boillot O, Muiesan P, Sharif K. Can donor liver left lateral sector weight be predicted from anthropometric variables? Pediatr Transplant. 2012;16:239–43.

    Article  PubMed  Google Scholar 

  54. Fukazawa K, Yamada Y, Nishida S, Hibi T, Arheart KL, Pretto EA. Determination of the safe range of graft size mismatch using body surface area index in deceased liver transplantation. Transpl Int. 2013;26:724–33.

    Article  PubMed  Google Scholar 

  55. De Ville de Goyet J, di Francesco F, Sottani V, Grimaldi C, Tozzi AE, Monti L, Muiesan P. Splitting livers: trans-hilar or trans-umbilical division? Technical aspects and comparative outcomes. Pediatr Transplant. 2015;19:517–26.

    Article  PubMed  Google Scholar 

  56. Kilic M, Seu P, Goss JA. Maintenance of the celiac trunk with the left-sided liver allograft for in-situ split liver transplantation. Transplantation. 2002;73:1252–7.

    Article  PubMed  Google Scholar 

  57. Maggi U, De Feo TM, Andorno E, Cillo U, De Carlis L, Colledan M, Burra P, De Fazio N, Rossi G, Liver Transplantation and Intestine North Italy Transplant Study Group. Fifteen years and 382 extended right grafts from in situ split livers in a multicenter study: are these still extended criteria liver grafts? Liver Transpl. 2015;21:500–11.

    Article  PubMed  Google Scholar 

  58. Broelsch CE, Whitington PF, Emond JC, Heffron TG, Thistlethwaite JR, Stevens L, Piper J, Whitington SH, Lichtor JL. Liver transplantation in children from living related donors. Surgical technique and results. Ann Surg. 1991;214:428–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Deshpande RR, Heaton ND, Rela M. Surgical anatomy of segmental liver transplantation. Br J Surg. 2002;89:1078–88.

    Article  CAS  PubMed  Google Scholar 

  60. Chaib E, Bertevello P, Saad WA, Pinotti HW, Gama-Rodrigues J. The main hepatic anatomic variations for the purpose of split-liver transplantation. Hepato-Gastroenterology. 2007;75:688–92.

    Google Scholar 

  61. Hsu SL, Chen TY, Huang TL, Sun CK, Concejero AM, Tsang LL, Cheng YF. Left-sided gallbladder: its clinical significance and imaging presentations. World J Gastroenterol. 2007;13:6404–9.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Broering DC, Rogiers X, Malagò M, Bassas A, Broelsch CE. Vessel loop-guided technique for parenchymal transection in living donor or in situ split-liver procurement. Liver Transpl Surg. 1998;4:241.

    Article  CAS  PubMed  Google Scholar 

  63. Strasberg SM, Lowell JA, Howard TK. Reducing the shortage of donor livers: what would it take to reliably split livers for transplantation into two adult recipients? Liver Transpl Surg. 1999;5:437–50.

    Article  CAS  PubMed  Google Scholar 

  64. Rogiers X, Broering DC, Topp S, Gundlach M. Technical and physiological limits of split liver transplantation into two adults. Acta Chir Belg. 2000;100:272–5.

    CAS  PubMed  Google Scholar 

  65. Azoulay D, Castaing D, Adam R, Savier E, Delvart V, Karam V, Ming BY, Dannauoi M, Krissat J, Bismuth H. Split-liver transplantation for two adult recipients: feasibility and long-term outcomes. Ann Surg. 2001;233:565–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Renz JF, Yersiz H, Reichert PR, Hisatake GM, Farmer DG, Emond JC, Busuttil RW. Split-liver transplantation: a review. Am J Transplant. 2003;3:1323–35.

    Article  PubMed  Google Scholar 

  67. Humar A, Khwaja K, Sielaff TD, Lake JR, Payne WD. Technique of split liver transplant for two adult recipients. Liver Transpl. 2002;8:725–9.

    Article  PubMed  Google Scholar 

  68. Gundlach M, Broering D, Topp S, Sterneck M, Rogiers X. Split-cava technique: liver splitting for two adult recipients. Liver Transpl. 2000;6:703–6.

    Article  CAS  PubMed  Google Scholar 

  69. Broering DC, Bok P, Mueller L, Wilms C, Rogiers X. Splitting of the middle hepatic vein in full right-full left splitting of the liver. Liver Transpl. 2005;11:350–2.

    Article  PubMed  Google Scholar 

  70. Broelsch CE, Whitington PF, Emond JC, Heffron TG, Thistlethwaite JR, Stevens L, Piper J, Whitington SH, Lichtor JL. Liver transplantation in children from living related donors. Surgical techniques and results. Ann Surg. 1991;214:428–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Emond JC, Heffron TG, Whitington PF, Broelsch CE. Reconstruction of the hepatic vein in reduced size hepatic transplantation. Surg Gynecol Obstet. 1993;176:11–7.

    CAS  PubMed  Google Scholar 

  72. Kilic M, Aydinli B, Aydin U, Alper M, Zeytunlu M. A new surgical technique for hepatic vein reconstruction in pediatric live donor liver transplantation. Pediatr Transplant. 2008;12:677–81.

    Article  PubMed  Google Scholar 

  73. Sommovilla J, Doyle MM, Vachharajani N, Saad N, Nadler M, Turmelle YP, Weymann A, Chapman WC, Lowell JA. Hepatic venous outflow obstruction in pediatric liver transplantation: technical considerations in prevention, diagnosis, and management. Pediatr Transplant. 2014;18:497–502.

    Article  CAS  PubMed  Google Scholar 

  74. Tannuri U, Tannuri ACA, Santos MM, Miyatani HT. Technique advance to avoid hepatic venous outflow obstruction in pediatric living-donor liver transplantation. Pediatr Transplant. 2015;19:261–6.

    Article  PubMed  Google Scholar 

  75. Sakamoto S, Egawa H, Kanazawa H, Shibata T, Miyagawa-Hayashino A, Haga H, Ogura Y, Kasahara M, Tanaka K, Uemoto S. Hepatic venous outflow obstruction in pediatric living donor liver transplantation using left-sided lobe grafts: Kyoto University experience. Liver Transpl. 2010;16:1207–14.

    Article  PubMed  Google Scholar 

  76. Tannuri U, Santos MM, Tannuri ACA, Gibelli NE, Moreira A, Carnevale FC, Ayoub AA, Maksoud-Filho JC, Andrade WC, Velhote MC, Silva MM, Pinho-Apezzato ML, Miyatani HT, Guimaraes RR. Which is the best technique for hepatic venous reconstruction in pediatric living-donor liver transplantation? Experience from a single center. J Pediatr Surg. 2011;46:1379–84.

    Article  PubMed  Google Scholar 

  77. Camagni S, Lucianetti A, Pinelli D, D’Antiga L, Colledan M. Replacement versus preservation of the native vena cava in pediatric liver transplantation with left lateral segment grafts. Abstracts of the 18th Congress of the European Society for Organ Transplantation, 24-27 September 2017, Barcelona. Transpl Int. 2017;30:331.

    Google Scholar 

  78. Varela-Fascinetto G, Castaldo P, Fox IJ, Sudan D, Heffron TG, Shaw BW, Langnas AN. Biliary atresia-polysplenia syndrome. Surgical and clinical relevance in liver transplantation. Ann Surg. 1998;227:583–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  79. Mitchell A, John PR, Mayer DA, Mirza DF, Buckels JA, de Ville de Goyet J. Improved technique of portal vein reconstruction in pediatric liver transplant recipient with portal vein hypoplasia. Transplantation. 2002;73:1244–7.

    Article  PubMed  Google Scholar 

  80. Marwan IK, Fawzy AT, Egawa H, Inomata Y, Uemoto S, Asonuma K, Kiuchi T, Hayashi M, Fujita S, Ogura Y, Tanaka K. Innovative techniques for and results of portal vein reconstruction in living-related liver transplantation. Surgery. 1999;125:265–70.

    Article  CAS  PubMed  Google Scholar 

  81. De Magnee C, Bourdeaux C, De Dobbeleer F, Janssen M, Menten R, Clapuyt P, Reding R. Impact of pre-transplant liver hemodynamics and portal reconstruction techniques on post-transplant portal vein complications in pediatric liver transplantation—a retrospective analysis in 197 recipients. Ann Surg. 2011;254:55–61.

    Article  PubMed  Google Scholar 

  82. Howard ER, Davenport M. Congenital extrahepatic portocaval shunts: the Abernethy malformation. J Pediatr Surg. 1997;32:494–7.

    Article  CAS  PubMed  Google Scholar 

  83. Guarrera JV, Sinha P, Lobritto SJ, Brown RS Jr, Kinkhabwala M, Emond JC. Microvascular hepatic artery anastomosis in pediatric segmental liver transplantation: microscope vs loupe. Transpl Int. 2004;17:585–8.

    Article  PubMed  Google Scholar 

  84. Heffron TG, Welch D, Pillen T, Fasola C, Redd D, Smallwood GA, Martinez E, Atkinson G, Guy M, Nam C, Henry S, Romero R. Low incidence of hepatic artery thrombosis after pediatric liver transplantation without the use of intraoperative microscope or parenteral anticoagulation. Pediatr Transplant. 2005;9:486–90.

    Article  PubMed  Google Scholar 

  85. Darwish AA, Bourdeaux C, Kader HA, Janssen M, Sokal E, Lerut J, Ciccarelli O, Veyckemans F, Otte JB, de Ville de Goyet J, Reding R. Pediatric liver transplantation using left hepatic segments from living related donors: surgical experience in 100 recipients at Saint-Luc University Clinics. Pediatr Transplant. 2006;10:345–53.

    Article  PubMed  Google Scholar 

  86. Enne M, Pacheco-Moreira L, Balbi E, Cerqueira A, Alves J, Valladares MA, Santalucia G, Martinho JM. Hepatic artery reconstruction in pediatric living donor liver transplantation under 10 Kg, without microscope use. Pediatr Transplant. 2010;14:48–51.

    Article  PubMed  Google Scholar 

  87. Tannuri AC, Monteiro RF, Santos MM, Miyatani HT, Tannuri U. A new simplified technique of arterial reconstruction in pediatric living-donor liver transplantation: a comparison with the classical technique. J Pediatr Surg. 2014;49:1518–21.

    Article  PubMed  Google Scholar 

  88. De Ville de Goyet J, Lo Zupone C, Grimaldi C, D’Ambrosio G, Candusso M, Monti L. Meso-Rex bypass as an alternative technique for portal vein reconstruction at or after liver transplantation in children: review and perspectives. Pediatr Transplant. 2013;17:19–26.

    Article  PubMed  Google Scholar 

  89. Roberts JP, Hulbert-Shearon TE, Merion RM, Wolfe RA, Port FK. Influence of graft type on outcomes after pediatric liver transplantation. Am J Transplant. 2004;4:373–7.

    Article  PubMed  Google Scholar 

  90. Soltys KA, Mazariegos GV, Squires RH, Sindhi RK, Anand R, the SPLIT Research Group. Late graft loss or death in pediatric liver transplantation: an analysis of the SPLIT database. Am J Transplant. 2007;7:2165–71.

    Article  CAS  PubMed  Google Scholar 

  91. Diamond IR, Fecteau A, Millis JM, Losanoff JE, Ng V, Anand R, Song C, the SPLIT Research Group. Impact of graft type on outcome in pediatric liver transplantation. A report from Studies of Pediatric Liver Transplantation (SPLIT). Ann Surg. 2007;246:301–10.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Abt PL, Rapaport-Kelz R, Desai NM, Frank A, Sonnad S, Rand E, Markmann JF, Shaked A, Olthoff KM. Survival among pediatric liver transplant recipients: impact of segmental grafts. Liver Transpl. 2004;10:1287–93.

    Article  PubMed  Google Scholar 

  93. Becker NS, Barshes NR, Aloia TA, Nguyen T, Rojo J, Rodriguez JA, O’Mahony CA, Karpen SJ, Goss JA. Analysis of recent pediatric orthotopic liver transplantation outcomes indicates that allograft type is no longer a predictor of survivals. Liver Transpl. 2008;14:1125–32.

    Article  PubMed  Google Scholar 

  94. Cauley RP, Vakili K, Potanos K, Fullington N, Graham DA, Finkelstein JA, Kim HB. Deceased donor liver transplantation in infants and small children: are partial grafts riskier than whole organs? Liver Transpl. 2013;19:721–9.

    Article  PubMed  Google Scholar 

  95. Alexopoulos SP, Nekrasov V, Cao S, Groshen S, Kaur N, Genyk YS, Matsuoka L. Effect of recipient size and allograft type on pediatric liver transplantation for biliary atresia. Liver Transpl. 2017;23:221–33.

    Article  PubMed  Google Scholar 

  96. Hong JC, Yersiz H, Farmer DG, Duffy JP, Ghobrial RM, Nonthasoot B, Collins TE, Hiatt JR, Busuttil RW. Longterm outcomes for whole and segmental liver grafts in adult and pediatric liver transplant recipients: 1 10-year comparative analysis of 2988 cases. J Am Coll Surg. 2009;208:682–91.

    Article  PubMed  Google Scholar 

  97. Broering DC, Kim JS, Mueller T, Fischer L, Ganschow R, Bicak T, Mueller L, Hillert C, Wilms C, Hinrichs B, Helmke K, Pothmann W, Burdelski M, Rogiers X. One hundred thirty-two consecutive pediatric liver transplants without hospital mortality. Lessons learned and outlook for the future. Ann Surg. 2004;240:1002–12.

    Article  PubMed  PubMed Central  Google Scholar 

  98. Gridelli B, Spada M, Petz W, Bertani A, Lucianetti A, Colledan M, Altobelli M, Alberti D, Guizzetti M, Riva S, Melzi ML, Stroppa P, Torre G. Split-liver transplantation eliminates the need for living-donor liver transplantation in children with end-stage cholestatic liver disease. Transplantation. 2003;75:1197–203.

    Article  PubMed  Google Scholar 

  99. Bourdeaux C, Darwish A, Jamart J, Tri TT, Janssen M, Lerut J, Otte JB, Sokal E, de Ville de Goyet J, Reding R. Living-related versus deceased donor pediatric liver transplantation: a multivariate analysis of technical and immunological complications in 235 recipients. Am J Transplant. 2007;7:440–7.

    Article  CAS  PubMed  Google Scholar 

  100. Battula NR, Platto M, Anbarasan R, Perera MT, Ong E, Roll GR, Ferraz Neto BH, Mergental H, Isaac J, Muiesan P, Sharif K, Mirza DF. Intention to split policy. A successful strategy in a combined pediatric and adult liver transplant center. Ann Surg. 2017;265:1009–15.

    Article  PubMed  Google Scholar 

  101. Spada M, Gridelli B, Colledan M, Segalin A, Lucianetti A, Petz W, Riva S, Torre G. Extensive use of split liver for pediatric liver transplantation: a single-center experience. Liver Transpl. 2000;6:415–28.

    Article  CAS  PubMed  Google Scholar 

  102. Hsu EK, Mazariegos GV. Global lessons in graft type and pediatric liver allocation: a path toward improving outcomes and eliminating wait-list mortality. Liver Transpl. 2017;23:86–95.

    Article  PubMed  Google Scholar 

  103. Hackl C, Schlitt HJ, Melter M, Knoppke B, Loss M. Current developments in pediatric liver transplantation. World J Hepatol. 2015;7:1509–20.

    Article  PubMed  PubMed Central  Google Scholar 

  104. Mazariegos GV. Critical elements in pediatric allograft selection. Liver Transpl. 2017;23:S56–8.

    Article  PubMed  Google Scholar 

  105. Lund DP, Lillehei CW, Kevy S, Perez-Atayde A, Maller E, Treacy S, Vacanti JP. Liver transplantation in newborn liver failure: treatment for neonatal hemochromatosis. Transplant Proc. 1993;25:1068–71.

    CAS  PubMed  Google Scholar 

  106. Bonatti H, Muiesan P, Connelly S, Baker A, Mieli-Vergani G, Gibbs P, Heaton N, Rela M. Hepatic transplantation in children under 3 months of age: a single centre’s experience. J Pediatr Surg. 1997;32:486–8.

    Article  CAS  PubMed  Google Scholar 

  107. Cacciarelli TV, Esquivel CO, Moore DH, Cox KL, Berquist WE, Concepcion W, Hammer GB, So SK. Factors affecting survival after orthotopic liver transplantation in infants. Transplantation. 1997;64:242–8.

    Article  CAS  PubMed  Google Scholar 

  108. Woodle ES, Millis JM, So SK, McDiarmid SV, Busuttil RW, Esquivel CO, Whitington PF, Thistlethwaite JR. Liver transplantation in the first three months of life. Transplantation. 1998;66:606–9.

    Article  CAS  PubMed  Google Scholar 

  109. Noujaim HM, Mayer DA, Buckles JA, Beath SV, Kelly DA, McKiernan PJ, Mirza DF, de Ville de Goyet J. Techniques for and outcome of liver transplantation in neonates and infants weighting up to 5 kilograms. J Pediatr Surg. 2002;37:159–64.

    Article  CAS  PubMed  Google Scholar 

  110. Mekeel KL, Langham MR, Gonzalez-Peralta RP, Hemming AW. Liver transplantation in very small infants. Pediatr Transplant. 2007;11:66–72.

    Article  PubMed  Google Scholar 

  111. Lucianetti A, Guizzetti M, Bertani A, Corno V, Maldini G, Pinelli D, Aluffi A, Codazzi D, Spotti A, Spada M, Gridelli B, Torre G, Colledan M. Liver transplantation in children weighting less than 6 Kg: the Bergamo experience. Transplant Proc. 2005;37:1143–5.

    Article  CAS  PubMed  Google Scholar 

  112. Sundaram SS, Alonso EM, Whitington PF. Liver transplantation in neonates. Liver Transpl. 2003;9:783–8.

    Article  PubMed  Google Scholar 

  113. Tolosa L, Pareja-Ibars E, Donato MT, Cortes M, Lopez S, Jimenez N, Mir J, Castell JV, Gomez-Lechon MJ. Neonatal livers: a source for the isolation of good-performing hepatocytes for cell transplantation. Cell Transplant. 2014;23:1229–42.

    Article  PubMed  Google Scholar 

  114. Pareja-Ibars E, Cortes M, Tolosa L, Gomez-Lechon MJ, Lopez S, Castell JV, Mir J. Hepatocyte transplantation program: lessons learned and future strategies. World J Gastroenterol. 2016;22:874–86.

    Article  CAS  Google Scholar 

  115. Enne M, Pacheco-Moreira L, Balbi E, Cerqueira A, Santalucia G, Martinho JM. Liver transplantation with monosegments. Technical aspects and outcome: a meta-analysis. Liver Transpl. 2005;11:564–9.

    Article  PubMed  Google Scholar 

  116. Kiuchi T, Kasahara M, Uryuhara K, Inomata Y, Uemoto S, Asonuma K, Egawa H, Fujita S, Hayashi M, Tanaka K. Impact of graft size mismatching on graft prognosis in liver transplantation from living donors. Transplantation. 1999;67:321–7.

    Article  CAS  PubMed  Google Scholar 

  117. Azouz SM, Diamond IR, Fecteau A. Graft type in pediatric liver transplantation. Curr Opin Organ Transplant. 2011;16:494–8.

    Article  PubMed  Google Scholar 

  118. Srinivasan P, Vilca-Melendez H, Muiesan P, Prachalias A, Heaton ND, Rela M. Liver transplantation with monosegments. Surgery. 1999;126:10–2.

    Article  CAS  PubMed  Google Scholar 

  119. Attia MS, Stringer MD, McClean P, Prasad KR. The reduced left lateral segment in pediatric liver transplantation: an alternative to the monosegment graft. Pediatr Transplant. 2008;12:696–700.

    Article  CAS  PubMed  Google Scholar 

  120. Thomas N, Thomas G, Verran D, Stormon M, O’Loughlin E, Shun A. Liver transplantation in children with hyper-reduced grafts. A single-center experience. Pediatr Transplant. 2010;14:426–30.

    Article  PubMed  Google Scholar 

  121. Cescon M, Spada M, Colledan M, Andorno E, Valente U, Rossi G, Reggiani P, Grazi GL, Tisone G, Majno P, Rogiers X, Santamaria ML, Baccarani U, Ettorre GM, Cillo U, Rossi M, Scalamogna M, Gridelli B. Split-liver transplantation with pediatric donors: a multicenter experience. Transplantation. 2005;79:1148–53.

    Article  PubMed  Google Scholar 

  122. Cescon M, Spada M, Colledan M, Torre G, Andorno E, Valente U, Rossi G, Reggiani P, Cillo U, Baccarani U, Grazi GL, Tisone G, Filipponi F, Rossi M, Ettorre GM, Salizzoni M, Cuomo O, De Feo T, Gridelli B. Feasibility and limits of split liver transplantation from pediatric donors. An Italian multicenter experience. Ann Surg. 2006;244:805–14.

    Article  PubMed  PubMed Central  Google Scholar 

  123. Khorsandi SE, Day AW, Cortes M, Deep A, Dhawan A, Vilca-Melendez H, Heaton N. Is size the only determinant of delayed abdominal closure in pediatric liver transplant? Liver Transpl. 2017;23:352–60.

    Article  PubMed  Google Scholar 

  124. De Ville de Goyet J, Struye de Swielande Y, Reding R, Sokal EM, Otte JB. Delayed primary closure of the abdominal wall after cadaveric and living related donor liver graft transplantation in children: a safe and useful technique. Transpl Int. 1998;11:117–22.

    Article  PubMed  Google Scholar 

  125. Caso Maestro O, Abradelo de Usera M, Justo Alonso I, Calvo Pulido J, Manrique Municio A, Cambra Molero F, Garcia Sesma A, Loinaz Segurola C, Moreno Gonzalez E, Jimenez Romero C. Porcine acellular dermal matrix for delayed abdominal wall closure after pediatric liver transplantation. Pediatr Transplant. 2014;18:594–8.

    Article  CAS  PubMed  Google Scholar 

  126. Karpelowsky JS, Thomas G, Shun A. Definitive abdominal wall closure using a porcine intestinal submucosa biodegradable membrane in pediatric transplantation. Pediatr Transplant. 2009;13:285–9.

    Article  PubMed  Google Scholar 

  127. Gondolesi G, Selvaggi G, Tzakis A, Rodriguez-Laiz G, Gonzalez-Campana A, Fauda M, Angelis M, Levi D, Nishida S, Iyer K, Sauter B, Podesta L, Kato T. Use of the abdominal rectus fascia as a nonvascularized allograft for abdominal wall closure after liver, intestinal, and multivisceral transplantation. Transplantation. 2009;87:1884–8.

    Article  PubMed  Google Scholar 

  128. Jones VS, Thomas G, Stormon M, Shun A. The ping-pong ball as a surgical aid in liver transplantation. J Pediatr Surg. 2008;43:1745–8.

    Article  PubMed  Google Scholar 

  129. Matsuura T, Soejima Y, Taguchi T. Auxiliary partial orthotopic living donor liver transplantation with a small-for-size graft for congenital absence of the portal vein. Liver Transpl. 2010;16:1437–9.

    Article  PubMed  Google Scholar 

  130. Bartlett A, Rela M. Progress in surgical techniques in pediatric liver transplantation. Pediatr Transplant. 2010;14:33–40.

    Article  PubMed  Google Scholar 

  131. Faraj W, Dar F, Bartlett A, Vilca-Melendez H, Marangoni G, Mukherji D, Mieli-Vergani G, Dhawan A, Heaton N, Rela M. Auxiliary liver transplantation for acute liver failure in children. Ann Surg. 2010;251:351–6.

    Article  PubMed  Google Scholar 

  132. Weiner J, Griesemer A, Island E, Lobritto S, Martinez M, Selvaggi G, Lefkowitch J, Velasco M, Tryphonopoulos P, Emond J, Tzakis A, Kato T. Longterm outcomes of auxiliary partial orthotopic liver transplantation in preadolescent children with fulminant hepatic failure. Liver Transpl. 2016;22:485–94.

    Article  PubMed  Google Scholar 

  133. D’Antiga L, Colledan M. Surgical gene therapy by domino auxiliary liver transplantation. Liver Transpl. 2015;21:1338–9.

    Article  PubMed  Google Scholar 

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  1. Department of Organ Failure and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy

    Michele Colledan & Stefania Camagni

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  1. Michele Colledan
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Correspondence to Michele Colledan .

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

    Lorenzo D'Antiga

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Colledan, M., Camagni, S. (2019). Surgical Techniques. In: D'Antiga, L. (eds) Pediatric Hepatology and Liver Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-96400-3_27

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