Whole Deceased Donor Liver Transplantation in Pediatric Recipients Less than 10 Kg. Retrospective Analysis of Outcome and Surgical Complications

Abstract

Background Whole deceased donor liver transplantation (DDLT) in small pediatric recipients (defined as children < 10 Kg) is mostly limited by unavailability of suitable graft, technical challenges and questionable function of a young graft. Actually less than 35% of patients younger than 1 year of age receive a whole-DDLT. 2-years patient and graft survival are reported about 90% and 80% respectively. Overall morbidity is approximally 45%. Vascular and biliary complication have been observed in up to 25% and 7.5% after whole-DDLT respectively. A donor-to-recipient weight ratio (DRWR)<1,5 is considerd as risk for complications. Aim of the study is to determine the outcomes after whole-DDLT in small pediatric recipients. Methods We retrospectively analysed all pediatric whole-DDLT between 2005 and 2016 at our centre and evaluated the patient and graft survival and the surgical complications in small children with a weight less than 10 kg. Results From 2005 to 2016 we performed 35 whole-DDLT. 12 of them (35%) weighed less than 10kg (median weight 6,1kg (3,5-8,3) at a median age of 10 months (10 days-24 months)). The donors’ median weight was 6,75kg (4-16kg) and median age 6 months (1-36 months). The median DRWR was 1,2 (0,6-4). The indications of LT were cholestatic disorders in 9 patients and metabolic liver diseases in 3. No delayed closure or a patch was needed. Primary function rate was 100%. 3 patients experienced biliary complications and one patient kinking of the hepatic artery. All of them were reoperated. After a median follow-up-time of four years (7-84 months) graft survival is 100%. Overall patient survivals were 100% and 92% at 2 and 5 years, as one patient died at POM 34 because of HSV sepsis. Conclusion Excellent results can be achieved in whole-DDLT in small recipients despite a DRWR<1,5.