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Original Investigation
January 2014

Segmental Grafts in Adult and Pediatric Liver Transplantation: Improving Outcomes by Minimizing Vascular Complications

Author Affiliations
  • 1Section of Transplantation and Immunology, Department of Surgery, Yale University School of Medicine, Yale–New Haven Transplantation Center, New Haven, Connecticut
JAMA Surg. 2014;149(1):63-70. doi:10.1001/jamasurg.2013.3384
Abstract

Importance  The use of technically variant segmental grafts are key in offering transplantation to increase organ availability.

Objective  To describe the use of segmental allograft in the current era of donor scarcity, minimizing vascular complications using innovative surgical techniques.

Design, Setting, and Participants  Retrospective study from August 2007 to August 2012 at a university hospital. A total of 218 consecutive liver transplant patients were reviewed, and 69 patients (31.6%; 38 males and 31 females; mean age, 22.5 years) received segmental grafts from living donors or split/reduced-size grafts from deceased donors.

Main Outcomes and Measures  Graft type, vascular and biliary complications, and patient and graft survival.

Results  Of 69 segmental transplants, 47 were living donor liver transplants: 13 grafts (27.7%) were right lobes, 22 (46.8%) were left lobes, and 12 (25.5%) were left lateral segments. Twenty-two patients received deceased donor segmental grafts; of these, 11 (50.0%) were extended right lobes, 9 (40.9%) were left lateral segments, 1 (4.5%) was a right lobe, and 1 (4.5%) was a left lobe. Arterial anastomoses were done using 8-0 monofilament sutures in an interrupted fashion for living donor graft recipients and for pediatric patients. Most patients received a prophylactic dose of low-molecular-weight heparin for a week and aspirin indefinitely. There was no incidence of hepatic artery or portal vein thrombosis. Two patients developed hepatic artery stenosis and were treated with balloon angioplasty by radiology. Graft and patient survivals were 96% and 98%, respectively.

Conclusions and Relevance  Use of segmental allografts is essential to offer timely transplantation and decrease waiting list mortality. Living donor liver transplants and segmental grafts from deceased donors are complementary. It is possible to have excellent outcomes combining a multidisciplinary team approach, technical expertise, routine use of anticoagulation, and strict patient and donor selection.

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