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Carlos O. Esquivel, MD, PhD; Paul Nakazato, MD; Kenneth Cox, MD; Waldo Concepcion, MD; William Berquist, MD; Thomas R. Russell, MD

Arch Surg. 1991;126(10):1278-1286.

Abstract
• Reduced-size liver transplantation (RSLT) in children was introduced to alleviate a shortage of small-organ donors. The impact of RSLT on the waiting time for an organ and on morbidity and mortality was investigated. Between March 25, 1988, and August 11, 1990, 61 hepatic transplantations were performed in 55 children at the Pacific Transplant Institute in San Francisco, Calif. Full-size liver transplantation was performed in 41 cases and RSLT in 20 cases. The overall 30-month actuarial patient and graft survival rates were 89% and 73%, respectively. A comparison between full-size liver transplantation and RSLT showed no difference in patient and graft survival, reoperations, infections, or rejection. Benefits of RSLT were an increase in the donor pool size, a decrease in waiting time for a suitable donor, and a decrease in the rate of arterial thrombosis. The main morbidity of RSLT was an increase in perioperative blood requirements. We conclude that RSLT offers small children with end-stage liver disease a chance for long-term survival.

(Arch Surg. 1991;126:1278-1286)

Author Affiliations
From the Pacific Transplant Institute at the California Pacific Medical Center, San Francisco, Calif.

Footnotes
Accepted for publication July 15, 1991.

Presented at the 62nd Annual Scientific Session of the Pacific Coast Surgical Association, Pebble Beach, Calif, February 20, 1991.

Reprint requests to Pacific Transplant Institute, Suite 425, 2340 Clay St, San Francisco, CA 94115 (Dr Esquivel).

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