{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T21:44:40Z","timestamp":1792014280166,"version":"4.4.0"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Langenbecks Arch Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Large-for-size mismatch remains a major challenge in pediatric and small recipient liver transplantation, particularly when full-size deceased-donor grafts are allocated and conventional splitting is not feasible.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a single-center retrospective analysis of seven pediatric and adolescent recipients who underwent deceased donor liver transplantation (DDLT) with ex-vivo right posterior sectionectomy (RPS) between 2018 and 2022. Grafts were considered oversized based on an integrated surgical assessment including graft-to-recipient weight ratio (GRWR), recipient abdominal anatomy, graft morphology, and expected graft fit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Median GRWR decreased from 4.7% to 2.2%, allowing graft implantation in all cases. Primary abdominal closure was achieved in six recipients, while one required delayed closure for large-for-size syndrome (LFS). No cases of severe LFS with hemodynamic, ventilatory, or graft perfusion compromise were observed. Major complications occurred in three patients, including one biliary complication requiring surgical revision, one primary graft failure requiring retransplantation, and one death unrelated to graft size or transplant surgery. At a median follow-up of 59.5 months among surviving recipients, six of seven patients were alive; five retained their original graft, while one was alive with a functioning second graft after retransplantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Ex-vivo RPS appears to be a technically feasible rescue graft reduction strategy in highly selected pediatric recipients when conventional graft reduction techniques are not feasible. Given the limited cohort size and the occurrence of primary graft failure and mortality, its safety and efficacy require further evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00423-026-04320-y","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T20:46:21Z","timestamp":1791924381000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ex-vivo right posterior sectionectomy for large-for-size mismatch in pediatric liver transplant recipients"],"prefix":"10.1007","volume":"411","author":[{"given":"Andrea","family":"Della Penna","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Hartleif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Quante","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvio","family":"Nadalin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"issue":"5","key":"4320_CR1","doi-asserted-by":"publisher","first-page":"1192","DOI":"10.1007\/s11605-019-04505-5","volume":"24","author":"P Addeo","year":"2020","unstructured":"Addeo P, Noblet V, Naegel B, Bachellier P (2020) Large-for-Size Orthotopic Liver Transplantation: a Systematic Review of Definitions, Outcomes, and Solutions. J Gastrointest Surg 24(5):1192\u20131200","journal-title":"J Gastrointest Surg"},{"issue":"10","key":"4320_CR2","doi-asserted-by":"publisher","first-page":"1294","DOI":"10.1002\/lt.24835","volume":"23","author":"MA Allard","year":"2017","unstructured":"Allard MA, Lopes F, Frosio F, Golse N, Sa Cunha A, Cherqui D et al (2017) Extreme large-for-size syndrome after adult liver transplantation: A model for predicting a potentially lethal complication. Liver Transpl 23(10):1294\u20131304","journal-title":"Liver Transpl"},{"issue":"7","key":"4320_CR3","doi-asserted-by":"publisher","first-page":"e14543","DOI":"10.1111\/petr.14543","volume":"27","author":"M Kasahara","year":"2023","unstructured":"Kasahara M, Sakamoto S (2023) Optimal graft size in pediatric living donor liver transplantation: How are children different from adults? Pediatr Transpl 27(7):e14543","journal-title":"Pediatr Transpl"},{"issue":"7","key":"4320_CR4","doi-asserted-by":"publisher","first-page":"e70186","DOI":"10.1111\/petr.70186","volume":"29","author":"S Sakamoto","year":"2025","unstructured":"Sakamoto S, Kasahara M (2025) Graft Characteristics to Optimize Outcomes in Pediatric Liver Transplantation. Pediatr Transpl 29(7):e70186","journal-title":"Pediatr Transpl"},{"key":"4320_CR5","doi-asserted-by":"publisher","first-page":"10177","DOI":"10.3389\/ti.2021.10177","volume":"35","author":"X Pu","year":"2021","unstructured":"Pu X, He D, Liao A, Yang J, Lv T, Yan L et al (2021) A Novel Strategy for Preventing Posttransplant Large-For-Size Syndrome in Adult Liver Transplant Recipients: A Pilot Study. Transpl Int 35:10177","journal-title":"Transpl Int"},{"issue":"12","key":"4320_CR6","doi-asserted-by":"publisher","first-page":"9552","DOI":"10.21037\/qims-24-507","volume":"14","author":"S Zhang","year":"2024","unstructured":"Zhang S, Zhou B, Chen P, Chen G (2024) In situ right posterior sectionectomy during liver procurement based on preoperative 3D planning to prevent extreme large-for-size syndrome in adult-to-adult liver transplantation: a case report. Quant Imaging Med Surg 14(12):9552\u20139562","journal-title":"Quant Imaging Med Surg"},{"issue":"3","key":"4320_CR7","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1097\/00000658-199009000-00015","volume":"212","author":"CE Broelsch","year":"1990","unstructured":"Broelsch CE, Emond JC, Whitington PF, Thistlethwaite JR, Baker AL, Lichtor JL (1990) Application of reduced-size liver transplants as split grafts, auxiliary orthotopic grafts, and living related segmental transplants. Ann Surg 212(3):368\u2013375 discussion 75\u20137","journal-title":"Ann Surg"},{"issue":"4","key":"4320_CR8","first-page":"351","volume":"46","author":"O Boillot","year":"1991","unstructured":"Boillot O (1991) [Graft reduction in pediatric hepatic transplantation: value, technique and results]. Pediatrie 46(4):351\u2013356","journal-title":"Pediatrie"},{"issue":"5","key":"4320_CR9","first-page":"532","volume":"111","author":"D Houssin","year":"1992","unstructured":"Houssin D, Soubrane O, Boillot O, Dousset B, Ozier Y, Devictor D et al (1992) Orthotopic liver transplantation with a reduced-size graft: an ideal compromise in pediatrics? Surgery 111(5):532\u2013542","journal-title":"Surgery"},{"issue":"3","key":"4320_CR10","doi-asserted-by":"publisher","first-page":"101349","DOI":"10.1016\/j.jceh.2024.101349","volume":"14","author":"M Kasahara","year":"2024","unstructured":"Kasahara M, Fukuda A, Uchida H, Yanagi Y, Shimizu S, Komine R et al (2024) Reduced Size Liver Grafts in Pediatric Liver Transplantation; Technical Considerations. J Clin Exp Hepatol 14(3):101349","journal-title":"J Clin Exp Hepatol"},{"issue":"7","key":"4320_CR11","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1016\/j.gassur.2024.04.022","volume":"28","author":"P Addeo","year":"2024","unstructured":"Addeo P, de Mathelin P, Bachellier P (2024) Graft reduction in adult liver transplantation: indications, techniques, and outcomes. J Gastrointest Surg 28(7):1067\u20131071","journal-title":"J Gastrointest Surg"},{"issue":"4","key":"4320_CR12","doi-asserted-by":"publisher","first-page":"e14510","DOI":"10.1111\/petr.14510","volume":"27","author":"G Rossignol","year":"2023","unstructured":"Rossignol G, Muller X, Dubois R, Rode A, Mabrut JY, Mohkam K (2023) Optimizing graft-recipient size matching in adolescent liver transplantation: Don\u2019t forget ex situ right posterior sectionectomy. Pediatr Transpl 27(4):e14510","journal-title":"Pediatr Transpl"},{"issue":"5","key":"4320_CR13","doi-asserted-by":"publisher","first-page":"1545","DOI":"10.1007\/s13304-025-02269-z","volume":"77","author":"P Addeo","year":"2025","unstructured":"Addeo P, De Mathelin P, Paul C, Bachellier P (2025) Ex situ right posterior sectionectomy (H6,7) as liver graft reduction to overcome mismatch for small-body size adult. Updates Surg 77(5):1545\u20131550","journal-title":"Updates Surg"},{"issue":"1","key":"4320_CR14","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1097\/SLA.0000000000006121","volume":"279","author":"S Eguchi","year":"2024","unstructured":"Eguchi S, Umeshita K, Soejima Y, Eguchi H, Egawa H, Fukumoto T et al (2024) An Analysis of 10,000 Cases of Living Donor Liver Transplantation in Japan: Special Reference to the Graft-Versus-Recipient Weight Ratio and Donor Age. Ann Surg 279(1):94\u2013103","journal-title":"Ann Surg"}],"container-title":["Langenbeck's Archives of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00423-026-04320-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00423-026-04320-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00423-026-04320-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T20:47:06Z","timestamp":1792010826000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00423-026-04320-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,13]]},"references-count":14,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4320"],"URL":"https:\/\/doi.org\/10.1007\/s00423-026-04320-y","relation":{},"ISSN":["1435-2451"],"issn-type":[{"value":"1435-2451","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,13]]},"assertion":[{"value":"17 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"282"}}