How many sections of a donor liver are adequate for reduced-size transplantation?

In reduced-size liver transplantation, the number of sections of a donor liver that are adequate depends on the recipient's size and the estimated liver volume required for successful engraftment. Generally, a minimum of two sections (segments) of the donor liver are used for reduced-size transplantation, but additional sections may be necessary in certain cases.

Here's a breakdown of the potential section configurations for reduced-size liver transplantation:

1. Left Lateral Segment Graft (LLSG): This involves using the left lateral segment (segments 2 and 3) of the donor liver. It is commonly utilized in pediatric liver transplantation or in adults with a small body size.

2. Left Hepatectomy (LH): In this approach, the entire left lobe of the donor liver (segments 2, 3, and 4) is transplanted. It is suitable for recipients with a larger body size compared to the LLSG.

3. Extended Left Hepatectomy (XLH): This extends the LH by including the middle hepatic vein (MHV) and the caudate lobe (segment 1). It provides more liver volume and may be used in cases where the recipient's liver volume requirements are higher.

4. Right Hepatectomy (RH): This involves transplanting the entire right lobe of the donor liver (segments 5, 6, 7, and 8). It is typically used in adult recipients with a larger body size.

5. Split-Liver Grafts: In split-liver transplantation, the donor liver is divided into two or more separate grafts that can be transplanted into different recipients. This allows the expansion of the donor pool and the opportunity for multiple transplantations from a single donor.

The decision regarding the appropriate number of sections and the specific configuration of the donor liver graft for reduced-size transplantation is made based on meticulous preoperative planning, assessment of the recipient's clinical condition, and the expertise of the transplant team.