Reduced-size grafts--the solution for hepatic artery thrombosis after pediatric liver transplantation?

Reduced-size liver grafts (RSG) were developed to alleviate the donor shortage for pediatric patients, particularly those requiring emergency transplantation. In theory, the large size of the hepatic artery available for anastomosis from RSG, as opposed to whole pediatric grafts, is less likely to lead to hepatic artery thrombosis (HAT). Therefore, the authors reviewed their experience with HAT, comparing RSG and whole-liver grafts in pediatric patients undergoing emergency liver transplantation. Despite the severity of illness of the recipients (UNOS status IV), and the intrinsic damage to the graft during reduction, HAT was not seen after RSG for emergency pediatric transplantation. In contrast, 29% of pediatric recipients who received whole grafts for emergency transplantation had HAT. RSG is a safe alternative to whole-liver grafts for pediatric liver transplantation, and may reduce the incidence of HAT.