Hyper-reduced grafts in living donor liver transplant: Techniques and outcomes

Table 1 Study features of donors and recipients

Ref.	Patients number, donor status	Mean age of donor (years)	Mean body weight of donor (kg)	Reduction technique and segment employed	Mean age of recipient (months)	Mean body weight of recipients (kg)
Strong et al[24]	1, DD	NR	65.0	MSG: III (BT)	4.0	4.7
Mentha et al[25]	1, DD	22	78.0	MSG: II (BT)	11.0	6.9
Srinivasan et al[14]	6, DD	8.8	33.7	RLLS: III (BT)	1.0	3.45
Noujaim et al[26]	2, DD	10.0	65.0	MSG: II (BT)	NR	2.60
Kasahara et al[8]	14, LD	32.0	61.1	HRLLS in-situ S: III, HRLLS in-situ S: II	7.0	5.95
Attia et al[27]	4, DD	46.5	64.5	HRLLS: III (BT)	2.8	4.90
Grabhorn et al[32]	10, DD	5.0	25.0	RLLS: 5, HRLLS: 4, (BT)	0.5	3.25
Enne et al[28]	12, LD	NR	NR	MSG: III	12.0	6.20
Thomas et al[30]	8, DD 1, LD	NR	NR	HRLLS: 9 (BT)	10.0	7.50
Shehata et al[3]	44, LD	34.0	NR	MSG III: 26 Reduced MS III: 18	7.0	5.45
Kanazawa et al[2]	31, LD	NR	NR	HRLLS (in-situ)	7.0	5.80
Sakamoto et al[20]	5, LD	36.0	66.6	MSG: II	5.0	6.20
Sanada et al[31]	13, LD	NR	NR	MSG II: 12 MSG III: 1	1.0	3.30
Kitajima et al[29]	89, LD	33.0	NR	HRLLS 47 MSG II: 42	7.3	5.90
Raices et al[33]	59, LD	31.0	69.0	HRLLS (BT)	14.0	8.00
Hirata et al[34]	25, LD	NR	NR	Medial reduction (in-situ)	10.0	7.10
Zakaria et al[35]	68, LD 6, DD	30.0	NR	LLS Split LLS	7.4	5.60
Malla et al[36]	7, LD	28.0	76.0	MSG	6.11	5.60

DD: Deceased donor; LD: Living donor; NR: Not reported; MSG: Monosegmental; BT: Back-table; HRLLS: Hyper-reduced left lateral sector; RLLS: Reduced left lateral sector.

Table 2 Indications for liver transplantation among the studies

Ref.	Indications
Strong et al[24]	Biliary atresia, re-transplantation and hepatic artery thrombosis (n = 1)
Mentha et al[25]	Biliary atresia and re-transplantation (n = 1)
Srinivasan et al[14]	Fulminant hepatic failure (n = 5), re-transplantation and hepatic artery thrombosis (n = 1)
Noujaim et al[26]	Fulminant hepatic failure (n = 2)
Kasahara et al[8]	Biliary atresia (n = 8), fulminant hepatic failure (n = 4) and hepatic artery thrombosis (n = 2)
Attia et al[27]	Fulminant hepatic failure (n = 1), biliary atresia (n = 1), medial reduction (n = 1) and re-transplantation (n = 1)
Grabhorn et al[32]	Fulminant hepatic failure (n = 10)
Enne et al[28]	Biliary atresia (n = 12)
Thomas et al[30]	Biliary atresia (n = 9)
Shehata et al[3]	Biliary atresia (n = 24), fulminant hepatic failure (n = 16) and medial reduction (n = 4)
Kanazawa et al[2]	Biliary atresia (n = 18), fulminant hepatic failure (n = 7) and medial reduction (n = 4)
Sakamoto et al[20]	Biliary atresia (n = 4) and methyl malonic acidaemia (n = 1)
Sanada et al[31]	Fulminant hepatic failure (n = 8), biliary atresia (n = 2) and others (n = 3)
Kitajima et al[29]	Biliary atresia (n = 50), fulminant hepatic failure (n = 17) and others (n = 22)
Raices et al[33]	Biliary atresia (n = 46), Alagille syndrome (n = 6) and others (n = 7)
Hirata et al[34]	Biliary atresia (n = 25)
Zakaria et al[35]	Biliary atresia (n = 28), progressive familial intrahepatic cholestasis (type I, II, III, IV) (n = 15), sclerosing cholangitis (n = 4), Alagille syndrome (n = 3), Crigler-Najjar syndrome (n = 2), Neonatal hemochromatosis (n = 3), Tyrosinaemia (n = 2) Congenital hepatic fibrosis (n = 1) Argininosuccinic aciduria (n = 1), Caroli disease (n = 4), Mitochondrial hepatopathy (n = 2) Fragile X syndrome (n = 1) and Cryptogenic cirrhosis (n = 4)
Malla et al[36]	Alloimmune hepatitis (n = 2), biliary atresia (n = 4) and acute liver failure (n = 1)

Table 3 Overall study outcomes among liver transplantation patients (monosegmental vs hyper-reduced left lateral sector or reduced left lateral sector)

Outcome parameters	MSG (n = 152)	HRLLS or RLLS (n = 245)
Mean age of recipients (years)	6.44	6.33
Mean body weight of recipients (kg)	5.39	13.92
Mean value of donor to recipient weight ratio	11.86	16.40
Mean proportion LD/DD	148/4	217/34
Mean graft weight (gm)	167.15	277.57
Complications
Thrombosis as HAT	1	2
Thrombosis as PVT	1	3
Sepsis	6	11
Death	15	22

DD: Deceased donor; LD: Living donor; MSG: Monosegmental; HRLLS: Hyper-reduced left lateral sector; RLLS: Reduced left lateral sector; HAT: Hepatic artery thrombosis; PVT: Portal vein thrombosis.

Table 4 Study outcomes especially one year survivability rate after liver transplantation

Ref.	Alive after 1 year (%)	LT techniques
Grabhorn et al[32]	60.0	RLLS and HRLLS (BT)
Enne et al[28]	82.0	MSG III
Shehata et al[3]	81.4	MSG III and reduced MS III
Kitajima et al[29]	97.6	HRLLS and MSG II
Raices et al[33]	74.0	HRLLS (BT)
Zakaria et al[35]	94.6	LLS and split LLS

MSG: Monosegmental; BT: Back-table; HRLLS: Hyper-reduced left lateral sector; RLLS: Reduced left lateral sector; LT: Liver transplantation.