Innovative techniques in pediatric liver transplantation: reduced-, split- and living-donor related liver transplantation.

In spite of the increased number of organ donations, the amount of livers available for pediatric patients does not meet requirements. In an attempt to expand the pool of grafts, several techniques of size reduction (RST) have been developed: reduced-liver transplantation (RLT), liver segment transplantation (LST), "split" liver transplantation (SLT) and living-donor liver transplantation (LDLT). The aim of this work is to study the contribution of these techniques to reduction of mortality in the waiting list and the increased risks that we inflict to our patients by using these procedures. We report our experience on RST in the last nine years (23 RLT, 5 LST, 2 SLT and 3 LDLT). More than a half of them were performed in an emergency. Overall survival in children with RST (67%) is similar to that of patients receiving a "whole graft" (74%). We did not find significant differences in the incidence of graft-related complications, only reintervention for abdominal bleeding was needed more often in the RST group (30%) than in whole graft group (24%). Our data confirm the safety of the RST procedures in the pediatric liver transplantation programs and they decrease the waiting-list mortality (2.5%) among the pediatric patients.