Helena Linge, Eva-Doreen Pfister, Vanessa Muth, Sahar Arbabzadah, Jan Forner, Lisa Felgendreff, Nicolas Richter, Markus Quante, Moritz Schmelzle, Ulrich Baumann, Philipp Felgendreff, Cornelius J Van Beekum
In this selected cohort, left lateral segment transplantation was associated with excellent outcomes across weight groups. Acceptable results in small infants were achieved despite higher GRWR in a specialized setting, supporting LLS grafts as an important option to improve access to timely pediatric transplantation.
BACKGROUND: Graft selection in small infants is challenging due to size mismatch and the associated risk of vascular or biliary complications.
METHODS: In this retrospective single-center study, 57 pediatric liver transplants using left lateral segment grafts performed between 2019 and 2024 were analyzed and compared by recipient weight (< 10 kg vs. ≥ 10 kg).
RESULTS: Overall graft survival was 88% in the < 10 kg group and 96% in the ≥ 10 kg group. Patient survival at 1, 2, and 4 years was similar between groups (p = 0.500). The graft-to-recipient weight ratio was significantly higher in smaller recipients (4.64% vs. 2.37%, p < 0.05), and hepatic artery thrombosis occurred only in this group (9%). Biliary complications were comparable between cohorts (27% vs. 30%). Acute cellular rejection (57% vs. 12%, p < 0.001) and 90-day readmissions (57% vs. 27%, p = 0.022) were significantly more common in children weighing ≥ 10 kg.
CONCLUSION: In this selected cohort, left lateral segment transplantation was associated with excellent outcomes across weight groups. Acceptable results in small infants were achieved despite higher GRWR in a specialized setting, supporting LLS grafts as an important option to improve access to timely pediatric transplantation.