Introduction: In pediatric living donor liver transplantation (LDLT), left lateral segments (LLS) are the most frequently used liver grafts, due to the standardized technique and good results. In the context of cadaveric organ scarcity a customized liver graft might be necessary for both extremely small infants and bigger children, considering the risks of small and large-for-size syndromes. In our country, the experience with right side living donor grafts is limited. The aim of this study is to communicate the experience from our living donor program with left side technical variant grafts according to graft to recipient weight ratio (GRWR) and anterior-posterior graft to recipient ratio (AP ratio).  
Methods:We report our living donor series, from March 2023 to February 2025. All the surgeries were performed by the same specialized team of adult and pediatric transplant surgeons. Donor and recipient CT scans were used for calculation and graft selection: GRWR 1.5-4% and AP ratio <1: LLS, GRWR >4% and AP ratio >1: reduced LLS, and GRWR <1.5%: left lobe (LL). Partitions were done in-situ during donor open surgery following previously described techniques. 
Results: 43 pediatric LDLT were performed during the study period, with 5 left side technical variants: 3 LL and 2 reduced LLS grafts. Biliary atresia and autoimmune cirrhosis were the primary diagnosis. Reduced LLS recipients had a median weight of 5.8kg and LL recipients 28.1kg. Median GRWR pretransplant calculation for LLS versus postraplant actual GRWR were 5.2 to 2.8% for reduced LLS, and 1.2 to 1.9% for LL. All 3 LL grafts required outflow venous reconstruction. Left side technical variant donors had uneventful post operatives courses. One LL recipient had a small for size syndrome, which improved with medical management. Living donor left side technical variant recipient survival was 80%, with one LL recipient who died due to an invasive fungal infection in the immediate post transplant period. Results were comparable to LLS living donors. 
Conclusion: Although technically demanding, living donor left side technical variant grafts are a safe and effective option to improve pediatric recipients accessibility to liver transplant.