Pediatric Liver Transplantation: Graft Types

Liver transplantation has evolved remarkably over the past few decades. There continues to be a rising demand for donor organs and a persistent shortage of deceased donors. In pediatric liver transplantation, due to size limitations and the number of available donors, surgeons have developed innovative techniques to expand organ availability. Among these innovations are technical variant grafts, modified liver grafts that enable successful transplantation even when whole-organ grafts are not available.

In 2023, among pediatric liver transplant recipients, more than half were younger than five years of age, 16.9% were 6-11 years of age and 20.6% were 12-17 years of age. Given the size range of young recipients, not all children can receive a whole liver at the time of transplantation. Often, children need smaller liver grafts. A technical variant graft is a partial liver used in transplantation instead of the whole organ. This makes transplantation possible when a full liver is too large. In 2023, approximately four out of every ten pediatric recipients received a partial or split liver.

Whole Liver

Sometimes the donor size matches the recipient size. When this occurs, we can use a whole graft for liver transplantation. Here, the liver is retrieved from a size-matched deceased donor and implanted as a whole graft. While sometimes possible, in smaller children, this is often not achievable.

Technical Variant Grafts

Reduced Size

A reduced size liver transplant involves obtaining a whole liver from an adult deceased donor which is then reduced in its size to match the recipient. We often use this technique for large children and small adults who require more than just a portion of the liver but not the whole liver.

Split Liver

Split liver transplantation involves obtaining a deceased donor liver and dividing it into two sections, leaving the vascular (arteries and veins) structures for the two portions of the liver intact. In this way, two partial organs are obtained from a single liver. This allows the ability to share grafts between two recipients.

Living Donor

Living donor liver transplant uses a living donor for liver transplantation. The living donor donates a portion of their liver to the pediatric recipient. With a living donor, children do not have to stand by on the waiting list for a deceased donor. Following donation, in the living donor and the recipient, the liver regenerates, allowing the livers to grow back to full size within a few months. Family members, friends, or charitable strangers can donate.

Why does this matter?

Technical variant grafts make it possible to transplant children or small adults when a full-size liver is too large, and with split liver allows one donor liver to save more than one life. It allows us to increase the number of available livers for transplantation. It helps children and small adults get liver transplants sooner.