Large-for-size syndrome prophylaxis in infant liver recipients with low body mass

Abstract

Transplantation of the left lateral section (LLS) of the liver is now an established practice for treating advanced diffuse and unresectable focal liver diseases in children, with variants of the LLS primarily used in infants. However, the surgical challenge of matching the size of an adult donor's graft to the volume of a child's abdomen remains significant. This review explores historical developments, various approaches to measuring the required functional liver mass, and techniques to prevent complications associated with large-for-size grafts in infants.

Keywords: Pediatric liver transplantation; Large-for-size syndrome; Preoperative evaluation of donor and recipient; Liver volumetry; Monosegmental transplantation; Left lateral sector graft; Reduced size liver graft; Abdominal wall reconstruction; Liver transplantation; Liver resection

Core Tip: Transplantation of the left lateral section is a well-established treatment for advanced liver diseases in children, particularly infants. This review highlights the ongoing challenge of matching adult donor grafts to the smaller abdominal capacity of pediatric recipients. It also discusses the evolution of surgical approaches, methods for accurately assessing required liver mass, and strategies for mitigating complications related to large-for-size grafts.