Early Morbidity and Survival After Left Lateral Segment Versus Whole Liver Graft Transplantation in Children
In brief
Unplanned surgery followed 43% of pediatric left-lateral liver transplants
In this single-center study, 43% of children receiving left-lateral grafts had an unplanned surgical reintervention within 90 days, compared with 8% after whole-liver grafts. Left-lateral graft recipients also had more early complications and longer hospital stays, but no significant differences in graft loss or survival emerged. The retrospective study included 95 children, so whether these findings hold across centers remains unclear.
- Journal
- Pediatric transplantation (Q2)
- Published
- 1 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Helena Linge, Eva-Doreen Pfister, Vanessa Muth, Sahar Arbabzadah, Jan Forner, Teresa Linge, et al.
- PMID
- 42899388
- DOI
- 10.1111/petr.70501
Why clinicians should know about it
- Picked for Pediatric Surgery (top studies of the week, 25 October 2026): Paediatric liver transplant graft choice and surgical morbidity
Abstract
BACKGROUND: Left lateral segment (LLS) grafts expand graft availability for infants and small children requiring liver transplantation (LT). However, their cumulative early postoperative burden compared with whole liver grafts (WLGs) remains incompletely characterized. METHODS: This retrospective single-center cohort study included 95 consecutive primary pediatric LT recipients treated between 2019 and 2024, comprising 56 LLS and 39 WLG recipients. Cumulative postoperative morbidity within 90 days was quantified using the Comprehensive Complication Index (CCI). Additional outcomes included biliary and vascular complications, unplanned surgical reinterventions, length of stay, graft loss, retransplantation, and graft and patient survival. RESULTS: LLS recipients were younger and smaller than WLG recipients. Cumulative 90-day morbidity was greater after LLS transplantation (median CCI 53 vs. 45, p = 0.002). LLS recipients had higher rates of bile leakage (18% vs. 3%, p = 0.024), intra-abdominal bleeding (15% vs. 0%, p = 0.019), and unplanned surgical reintervention (43% vs. 8%, p < 0.001). Although the overall incidence of biliary complications was similar between groups, anastomotic biliary strictures during follow-up were more frequent after WLG transplantation (28% vs. 9%, p = 0.014). Hospital stay was longer after LLS transplantation (median 43 vs. 27 days, p < 0.001). No statistically significant differences in graft loss, retransplantation, or graft and patient survival were detected between groups. CONCLUSIONS: LLS transplantation was associated with greater cumulative morbidity within 90 days, characterized by higher rates of bile leakage, intra-abdominal bleeding, unplanned surgical reintervention, and prolonged hospitalization. Despite this greater early postoperative burden, no statistically significant differences in graft loss, retransplantation, or graft and patient survival were detected during the available follow-up. These findings support continued use of LLS grafts to expand transplant access. Given the associated early morbidity, it highlights the importance of an experienced surgical and medical team.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.