The shortage of pediatric donor livers continues to be the most common cause of death in pediatric patients requiring liver transplantation. While the survival rate for pediatric patients after liver transplantation is commonly 80% at 1 year, 20-50% of pediatric patients die awaiting a transplant (1, 2). Most of these patients are either small or require emergent liver transplantation for fulminant hepatic failure. This problem has led several transplant centers to advocate transplantation of hepatic lobes or segments from adult donors into pediatric recipients (3). The technical difficulty of the left-lateral- segment graft (LLSG)* in particular has led to a slow acceptance of this procedure in the United States. We recently performed a transplant using a different orientation of the LLSG than previously reported. This allowed for better organ fit, decreased portal vein redundancy with better portal-vein size match, and a more advantageous bile-duct reconstruction. The approach decreased the technical difficulty of the LLSG and may improve its utility in small children.
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