At present, end-stage hepatic disease can only be cured by orthotopic liver transplantation. As a pediatric surgeon the writer of this thesis was interested in the problems that hamper the development of pediatric orthotopic liver transplantation and particularly in the problem of the shortage of appropriately sized donor livers. Matching of the size of the donor liver with the size of the recipient liver has been a general principle in clinical orthotopic liver transplantation,l-6 and insurmountable problems have been encountered when livers that were too large were transplanted.7,8 Matching for size is a special problem in pediatric orthotopic liver transplantation. The weight of the liver of the full-term infant is doubled at 2 years and tripled at 3 years; at 5 years it has increased 6 times, and the liver of an adult, weighing approximately 1500 gr, is 12 to 13 times as large as that of the newborn.9 Because of these age-related differences in the size of the liver, age-matched donor livers are required in pediatric liver transplantation. Pediatric donor livers, constitute only a small part of the total donor however, pool. 10 Moreover, adult candidates for liver transplantation compete for these livers, 4 , 11 which aggravates the problem of the shortage of donor livers in pediatric liver transplantation. This competition will increase further when heterotopic auxiliary transplantation becomes a truly therapeutic procedure. The group of pediatric liver transplantation candidates younger than 6 years of age is the most severely affected by the shortage of age-related donor livers. 6 The use of livers from anencephalic newborns in these children is theoretically attractive, 2 ' 4 and there is one report of a case in which such a liver was used in an adult recipient. 7 However, this potentially large pool of donor livers - the incidence of anencephaly being 1 in 1,000 births12 - is likely to decrease as a result of increasing prenatal diagnosis of the condition and the associated increasing abortion rate of these fetuses. Moreover, it is not certain whether successful transplantation of such livers is possible. An alternative solution for the problem of the discriminatory role of the size of the donor liver in recipient selection for orthotopic liver transplantation, would be the use of only part of a donor liver. The left lateral segment of an adult human liver, which accounts for about 25% of the total liver weight,9 could be used for this purpose. Survival after removal of all but that segment of the liver has proven to be possible in patients requiring hepatic tumor surgery.l3 The experimental study reported here was performed to assess in dogs the feasibility of replacing the native liver by part of a donor liver

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J. Jeekel (Hans) , J.C. Molenaar
Erasmus University Rotterdam
Erasmus MC: University Medical Center Rotterdam

Bax, K. (1984, June 27). Orthotopic nonauxiliary allotransplantation of part of the liver in dogs. Retrieved from