Technical Difficulties in Pediatric Living Donor Liver Transplantation

Abstract

Aim: Living donor liver transplantation for children is necessary because of the dramatic shortage of pediatric donors. Patient features and technical difficulties make this procedure specially challenging. This study reviews our experience in pediatric living donor liver transplants. Material and methods: 108 Pediatric liver transplants (57F, 51M) were performed from 1993 to 2011. Mean age was 1,9±2,3 y. Indication for transplant was cholestatic disease (73%) tumor (14%) metabolic (7%) cirrhosis (3%). And miscellanea (1%) Patient data were review with particular attention to technical difficulties, complications and long term results. Results: Microscope was used for arterial anastomosis in 65% of transplants, 15% of grafts presented more than one artery. Ten grafts had double hepatic vein, six required complex portal vein reconstruction, 4 underwent cava vein replacement with donor jugular vein and 9 had double bile duct. Sixteen (15%) had biliary complications. Five (4.6%) had hepatic artery thrombosis; 3 (2.7%) had portal vein thrombosis. Graft survival at 1, 5 and 10 years was 86%, 83% and 83% respectively; patient survival at 1, 5 and 10 years was 98%, 96% and 96%. Conclusions: Living donor liver transplantation is an excellent option for children. Advanced technical resources are required in order to minimize complications.