The outcomes of pediatric living donor liver transplantation using small-for-size grafts: experience of a single institute

Purpose We aimed to evaluate patients who had undergone pediatric LDLT with small-for-size graft (SFSG) and identify risk factors of graft failure to establish a preoperative graft selection strategy. Methods The data was collected retrospectively. SFSG was used in 14LDLTs (5.7 %) of 245 LDLTs performed between May 2001 and March 2014. The mean patient age and body weight at LDLT were 12.6 ± 2.0 years and 40.5 ± 9.9 kg, respectively. The graft type was left lobe in six patients, left + caudate lobe in seven patients, and posterior segment in one patient. Results The graft survival rates in SFSG and non-SFSG groups were 78.9 and 93.1 %, respectively ( p = 0.045). In the univariate analysis, bleeding volume during LDLT were an independent risk factors for graft failure ( p = 0.011). Graft failure was caused by sepsis in all three patients and occurred at a median of 70 postoperative days 70 (range 14–88 days). Among them, two cases showed high preoperative PELD/MELD score (PELD; 19.4 and MELD; 22, respectively). Conclusions Pediatric LDLT using SFSG had poor outcome and prognosis, especially when it accompanies the surgical infectious complications with preoperative high PELD/MELD scores.