Ex situ right posterior sectionectomy (H6,7) as liver graft reduction to overcome mismatch for small-body size adult.

Small body size has been associated with an increased hazard ratio for mortality and dropout on the liver transplantation (LT) waitlist especially in female candidates. These findings could be explained by differences in anthropometric between genders, mainly due to smaller right anteroposterior diameter (RAP) of the right abdominal cavity in female. Reduction of graft volume by partial hepatectomy namely ex situ right posterior liver sectionectomy (H6,7) has been recently described to reduce liver grafts in adults. At our center, 4 female recipients, median RAP of 14 cm underwent LT with liver undergoing H6,7 graft reduction. Upon reduction, the graft weight passed from a median of 1654 g (range, 1640-1800) to 1365 g (range, 1230-1450) while the ratio graft weight/RAP passed from 114 g/cm (mean 111, range 102-120) to 93.3 g/cm (mean 92, range 82-98.5). The median cold ischemia time was 411 min (range, 343-478 min) and at a median follow-up of 268 days, all patients were alive with no vascular nor biliary complications and no retransplantation. Ex situ right posterior liver sectionectomy (H6, 7) represents a valid technical option to overcome mismatch for small-body size adult during liver transplantation. The need for this procedure remains exceptional and limited to small-body size adult recipient in urgent need for LT (i.e., fulminant liver failure, impairment of general conditions, ACLF, cancers, etc.) in which split liver transplantation could not be realized and/or is not available.