Outcomes in pediatric liver transplantation using grafts from children donors after cardiac death from a single center

Abstract

Objective To evaluate the clinical outcome in pediatric liver transplantation (LT) using the grafts from children donors after cardiac death (DCD).Method The clinical data of 11 children aged from 4 months to 5 years who underwent LT operation using the graft from children DCD between Nov.2011 and May 2013 in our hospital were analyzed retrospectively.The 11 livers were taken out of the DCD by China organ transplant response system.The 11 donors were children aged from 7 months to 9 years who died of irreversible anoxic cerebral damage,severe brain injuries and intracalvarium benign tumor.The 11 recipients were 3 boys and 8 girls.There were 9 children with severe cirrhosis with biliary atresia,one with fulminant liver failure and one with hepatoglycogenosis.The recipients weight at the time of LT was 6.5～20 kg.The recipients' pediatric endstage liver disease scoring was 8.5 ～31.5.Nine DCD livers including 3 reduced-size livers were classic-orthotopically transplanted into the 9 recipients respectively and 2 DCD livers were subjected to piggyback liver transplantation.Biliary tract was reconstructed via Roux-en-Y operation in 9 recipients and the common hepatic duct was end-to-end anastomosed in 2 cases.The blood type of donor to recipient was identical in 4 cases and compatible in 7 cases.tacrolimus,mycophenolate mofetil and prednisone were used for postoperative immunosuppression.Result The everage weight of 11 DCD livers was 180～690 g,the mean warm ischemia time was 4.3 min,and the mean cold ischemia time was 10 h.The mean operation time of 11 recipients was 10.94 h,and the mean anhepatic phase was 78 min.The graft to recipient weight ratio (GRWR) was 2.25％～7.54％ (mean 4.35％) and the graft volume to the standard liver volume (GV/SLV) was 0.67 ～ 2.13 (mean 1.15).The postoperative complications included hepatic artery thrombus (HAT) in 4 cases,primary non-function (PNF) in one case,portal vein thrombus in 1 case,peritoneal cavity hematoma in 1 case,and chylous ascites in 1 case.Three recipients were died of HAT,and one was died of PNF.Seven recipients were discharged on the 22～52 day (mean 33) and in satisfactory condition to present.Conclusion The children DCD liver is a better graft for pediatric liver transplantation,but HAT is higher after operation.A perfect operative technique for pediatric liver transplantation using the grafts from children DCD should be searched. Key words: Donation after cardiac death; Children; Donor; Liver transplantation