Evolution and future perspectives for reduced-size hepatic transplantation

Reduced-size hepatic transplantation has evolved into a clinically useful procedure, particularly at institutions specializing in treating pediatric patients. It is being adopted by many of the hepatic transplantation institutions in the United States as a result of its effectiveness in providing a greater number of donors for small recipients and an outcome equal to full-size hepatic transplantation. It has led to the development of 'split-liver' transplantation, which is at present not universally applicable because of its complexity, but could double the supply of donors available to small patients. It is also the precursor of orthotopic auxiliary transplantation, which could become the preferred method for treating children with metabolic diseases, but no structural changes, such as cirrhosis. Finally, the knowledge gained in reduced-size hepatic transplantation will inevitably lead to transplantation using living donors, which could completely alleviate the shortage of donors for small patients.