Objective To investigate the application value of indocyanine green fluorescence(ICG)-guided laparoscopic anatomical monosegmentectomy in pediatric living donor liver transplantation.

Methods The retrospective and descriptive study was conducted. The clinical data of 2 pediatric recipients undergoing living donor liver transplantation and 2 donors who were admitted to the Beijing Friendship Hospital Affiliated to Capital Medical University from December 2019 to January 2020 were collected. Case 1 was female, aged 1 year, weighted 8.7 kg. The living donor was the father of case 1, aged 35 years and weighted 93.1 kg. Case 2 was male, aged 1 year, weighted 7.5 kg. The living donor was the father of case 2, aged 39 years and weighted 84.0 kg. Both of 2 donors underwent ICG-guided laparoscopic anatomical monosegmentectomy to obtain the graft. Observation indicators: (1) surgical situations of donors; (2) postoperative situations of donors; (3) postoperative situations of recipients; (4) follow-up. Follow-up was conducted using telephone interview, outpatient examination, mobile short message or the WeChat. Donors were followed up at postoperative 1, 3, 6 months to detect recovery of liver function. Recipients were followed up once a week postoperatively to detect graft function and complications including rejection, bile leakage, biliary stenosis, thrombosis, vascular stenosis up to July 2020.

Results (1) Surgical situations of donors: the total operation time, time of preparing reduced-size grafts, volume of intraoperative blood loss of the donor of case 1 were 234 minutes, 40 minutes, 60 mL, respectively. There was no blood transfusion during the operation and the final graft weight was 225.2 g after reducing size. The total operation time, time of preparing reduced-size grafts, volume of intra-operative blood loss of the donor of case 2 were 220 minutes, 40 minutes, 40 mL, respectively. There was no blood transfusion during the operation and the final graft weight was 178.0 g after reducing size. (2) Postoperative situations of donors: on the postoperative second day, the levels of alanine amino-transferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil)of the donor of case 1 reached the peak of 493 U/L, 186.0 U/L, 30.66 μmol/L, respectively, and then decreased to 388 U/L, 90.9 U/L, 22.57 μmol/L on the postoperative third day. The time to postoperative out-of-bed activity, time to postoperative initial liquid food intake, time to postoperative abdominal drainage tube removal, duration of postoperative hospital stay of the donor of case 1 were 2 days, 1 day, 3 days, 4 days, respectively. There was no Clavien-Dindo grade Ⅱ-Ⅴ complication occurred during the perioperative period. On the postoperative first day, the level of ALT, AST, TBil of the donor of case 2 reached the peak of 602 U/L, 454.6 U/L, 30.49 μmol/L, respectively, and then decreased to 355 U/L, 55.7 U/L,20.65 μmol/L on the postoperative fourth day. The time to postoperative out-of-bed activity, time to postoperative initial liquid food intake, time to postoperative abdominal drainage tube removal, duration of postoperative hospital stay of the donor of case 2 were 2 days, 1 day, 3 days, 5 days, respectively. There was no Clavien-Dindo grade Ⅱ-Ⅴcomplication occurred during the perioperative period. (3) Postoperative situations of recipients: on the postoperative first day, the levels of ALT, AST, TBil of case 1 reached the peak of 670 U/L, 288.7 U/L, 22.13 μmol/L, respectively, and then decreased to 54 U/L, 33.0 U/L, 5.75 μmol/L on the postoperative fourteenth day. The duration of postoperative hospital stay of case 1 was 20 days and there was no Clavien-Dindo grade Ⅱ-Ⅴ complication occurred during the perioperative period. On the postoperative first day, the levels of ALT, AST, TBil of case 2 reached the peak of 520 U/L, 93.9 U/L, 31.42 μmol/L, respectively, and then decreased to 87 U/L, 60.8 U/L, 11.51 μmol/L on the postoperative fourteenth day. The duration of postoperative hospital stay of case 2 was 25 days and there was no Clavien-Dindo grade Ⅱ-Ⅴ complication occurred during the perioperative period. (4) Follow-up: 2 donors were followed up at postoperative 1, 3, 6 months. The liver function of 2 donors recovered to normal level at postoperative 1 month, and no abnormal liver function was found at postoperative 3 months or 6 months. Two recipients were followed up weekly after. During the follow-up, both recipients had normal graft function and no complication such as rejection, bile leakage, biliary stricture, thrombosis or vascular stenosis emerged.

Conclusion ICG-guided laparoscopic anatomical mono-segmentectomy is safe and feasible in pediatric living donor liver transplantation, which can be performed by a team with rich experience in laparoscopic liver graft acquisition.