Extension of the indication for living related liver transplantation from children to adults based on resolution of graft size mismatch in relation to tissue oxygenation and metabolic load: a case report.

We extended the indication for living related partial liver transplantation from pediatric to adult cases. Our first case was a 49-year-old woman with primary biliary cirrhosis. Her sister's left lobe, weighing 280 g, was employed as a graft, and the graft weight/recipient's body weight ratio was calculated as 0.59%. To decrease the metabolic load to the relatively small graft, the total bilirubin was decreased from a maximum value of 75.0 mg/d1 to the most recent preoperative value of 36.2 mg/dl by plasma exchange. Intraoperative recovery of tissue oxygenation and its heterogeneity were satisfactory due to a relatively high blood supply. A postoperative decrease in bilirubin and increase in cholesterol esterification were facilitated, concomitant with regeneration of the graft, which weighed 280 g, to 860 cm3 at 3 weeks. Linear regression analysis with respect to tissue oxygenation and metabolic capacity obtained in pediatric cases were applied to this adult case.