Application of reduced-size liver transplants as split grafts, auxiliary orthotopic grafts, and living related segmental transplants.

摘要: The University of Chicago program in pediatric liver transplantation continues actively to seek innovative surgical solutions problems related the management children with end-stage disease. Among most important facing these is a shortage donor organs, which results from three factors addition actual supply donors: concentration disease population younger than 2 years; necessity for graft that small enough; and epidemiology accidents other events lead organ donation. Transplantation using lobe as overcomes size disparity shifts available organs older donors recipients. This work describes technical aspects recent innovations use lobes transplantation, simple reduced-size (RLT), split-liver (SLT), orthotopic auxiliary grafting (ALT), living (LRLT), compares their results. Since November 1986 total 61 procedures have been performed was used graft: 26 RLT; 30 SLT, 25 5 adults; LRLT; 1 ALT. Overall 62% transplants involved graft. rates complications are somewhat higher whole-liver but this may not be entirely result complex procedures. Split associated highest mortality complication rates. Living has recipients, date survival 100%. Orthotopic effectively corrected metabolic defect one patient ornithine transcarbamylase deficiency. various modalities reduction resulted postoperative similar those achieved full-size grafts, while pretransplantation limited less 2%. Thus grafts accomplishes goal reducing global among disease, at cost increased complexity more complications.