Liver Transplantation In Pediatric Recipients Research Articles

Whole liver deceased donor liver transplantation for pediatric recipients: single-center experience for 20 years.

BackgroundWe investigated the incidence and outcomes of pediatric deceased donor liver transplantation (DDLT) using whole liver grafts in a high-volume liver transplantation (LT) center.MethodsThe study was a retrospective single-center analysis of whole LT in pediatric recipients. The study period was set as 20 years between January 2000 and December 2019. We defined pediatric recipients and donors to be aged ≤18 years.ResultsDuring the study period, there were 98 cases of pediatric DDLT, and 34 patients (34.7%) received whole liver grafts. The age range of the deceased donors was 3 months to 56 years and that of pediatric recipients was 7 months to 17 years. Common primary diseases for LT were biliary atresia in 13, acute liver failure in four, Wilson disease in four, congenital portal vein agenesis in three, and genetic metabolic diseases in three. Pediatric-to-pediatric and adult-to-pediatric whole LTs were 22 (64.7%) and 12 (35.3%), respectively. A good correlation was noted between the donor and the recipient’s body weight, and the recipient’s body weight and allograft’s weight. Graft and overall patient survival rates were 91.2% and 91.2% at 1 year, 88.0% and 88.0% at 3 years, and 88.0% and 88.0% at 5 years, respectively.ConclusionsThe results of this study revealed that Korean Network for Organ Sharing (KONOS) regulations with donor-recipient body weight matching exhibited good performance. Considering the reciprocal trades of liver organs among pediatric and adult donors and recipients, it is necessary to establish a policy for pediatric donor liver grafts to pediatric recipients on a priority basis.

Whole liver deceased donor liver transplantation for pediatric recipients: single-center experience for 20 years

Background: We investigated the incidence and outcomes of pediatric deceased donor liver transplantation (DDLT) using whole liver grafts in a high-volume liver transplantation (LT) center. Methods: The study was a retrospective single-center analysis of whole LT in pediatric recipients. The study period was set as 20 years between January 2000 and December 2019. We defined pediatric recipients and donors to be aged ≤18 years. Results: During the study period, there were 98 cases of pediatric DDLT, and 34 pa tients (34.7%) received whole liver grafts. The age range of the deceased donors was 3 months to 56 years and that of pediatric recipients was 7 months to 17 years. Common primary diseases for LT were biliary atresia in 13, acute liver failure in four, Wilson dis ease in four, congenital portal vein agenesis in three, and genetic metabolic diseases in three. Pediatric-to-pediatric and adult-to-pediatric whole LTs were 22 (64.7%) and 12 (35.3%), respectively. A good correlation was noted between the donor and the re cipient’s body weight, and the recipient’s body weight and allograft’s weight. Graft and overall patient survival rates were 91.2% and 91.2% at 1 year, 88.0% and 88.0% at 3 years, and 88.0% and 88.0% at 5 years, respectively. Conclusions: The results of this study revealed that Korean Network for Organ Sharing (KONOS) regulations with donor-recipient body weight matching exhibited good perfor mance. Considering the reciprocal trades of liver organs among pediatric and adult do nors and recipients, it is necessary to establish a policy for pediatric donor liver grafts to pediatric recipients on a priority basis.

DONANTE VIVO HEPÁTICO ADULTO-PEDIÁTRICO TOTALMENTE LAPAROSCÓPICO. ASPECTOS TÉCNICOS Y RESULTADOS.

Introducción: La cirugía hepática laparoscópica ha presentado un desarrollo más lento debido a la complejidad que ésta posee, lo que determina una curva de aprendizaje prolongada. En relación a la hepatectomía laparoscópica para donante vivo en trasplante hepático (TH), ésta se ha retrasado aún más por las preocupaciones sobre la seguridad del donante, el resultado del injerto y la adquisición de las competencias técnicas de los cirujanos. El objetivo de este artículo, es exponer detalles técnicos de la hepatectomía izquierda laparoscópica de donantes vivos adultos para trasplante pediátrico y se presentan los resultados quirúrgicos de los casos realizados en este centro.Materiales y Métodos: Presentación de la técnica quirúrgica de la hepatectomía izquierda en donantes vivos para TH en receptores pediátricos además de realizar un estudio cohorte no concurrente de pacientes sometidos a esta cirugía en el Hospital Clínico de la Universidad Católica entre mayo de 2011 y noviembre de 2017.Resultados: La serie consta de 15 pacientes, 60% sexo femenino. Trece pacientes (86,6%) eran madre o padre del receptor. El 100% de pacientes fue sometido a hepatectomía izquierda laparoscópica sin necesidad de conversión. Morbilidad Clavien–Dindo > 3, 1 paciente requirió punción percutánea de bilioma. Mediana de hospitalización de 3 días (2-5). No hubo mortalidad.Conclusión: La hepatectomía izquierda por vía laparoscópica de donante vivo para TH pediátrico es un procedimiento seguro y factible de realizar en este centro, con excelentes resultados en términos de morbimortalidad y consideramos que esta técnica debe ser la vía de elección para donantes vivos adultos-pediátricos.

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

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.

Long-term Changes in Spleen Volume After Living Donor Liver Transplantation in Pediatric Recipients

BackgroundLiving donor liver transplantation (LDLT) is a definitive procedure for splenomegaly caused by liver cirrhosis and portal hypertension, but splenomegaly persists in some patients. The aim of this study was to clarify the long-term changes in the spleen volume after LDLT. MethodsThe 13 pediatric patients who survived for >8 years after LDLT were retrospectively analyzed. We calculated the spleen volume/standard spleen volume (SV/SSV) ratio by automated computed tomography (CT) volumetry. We assessed the spleen volumes before LDLT, at roughly postoperative week (POW) 4, at postoperative year (POY) 1, at POY 5, and at POY 10. ResultsWith regard to SV as evaluated by CT volumetry, there were no consistent trends, with median values as follows: before LDLT, 282.5 (71–641) cm3; POW 4, 252 (109–798) cm3; POY 1, 222.5 (97–948) cm3; POY 5, 263.5 (123–564) cm3; and POY 10, 377 (201–1080) cm3. In contrast, the SV/SSV ratio decreased chronologically as follows: before LDLT, 5.0 (0.7–6.0); POW 4, 3.7 (2.3–4.3); POY 1, 2.2 (1.7–6.3); POY 5, 1.7 (1.1–5.4); and POY 10, 1.4 (1.1–6.9). In the remote phase after LDLT, many cases showed a trend toward an improved SV/SSV ratio, but splenomegaly was prolonged without improvement in 3 cases (23.1%) with portal vein complications and advanced fibrosis. Furthermore, all 3 cases showed a decreased platelet count due to hypersplenism. ConclusionSplenomegaly requires a long time to demonstrate an improvement. In cases without an improvement of splenomegaly, we should suspect abnormalities in the graft liver and portal hemodynamics.

Maternal microchimerism in patients with biliary atresia

Maternal-fetal cellular trafficking during pregnancy results in bidirectional microchimerism with potentially long-term consequences for the mother and her fetus. Exposure of the fetus to maternal cells results in tolerance to non-inherited maternal antigens (NIMA) and may therefore impact transplant outcomes. We investigated the rates of graft failure and retransplantation after parental liver transplantation in pediatric recipients with biliary atresia (BA), a disease with high levels of maternal microchimerism. We observed significantly lower rates of graft failure and retransplantation in BA recipients of maternal livers compared with BA recipients of paternal livers. Importantly, recipients without BA had equivalent transplant outcomes with maternal and paternal organs, suggesting that increased maternal microchimerism in BA patients may be the underlying etiology for tolerance. These results support the concept that prenatal exposure to NIMA may have consequences for living-related organ transplantation.

A single center experience of donation after cardiac death liver transplantation in pediatric recipients

Many centers are now performing DCD adult LT. There has been a reluctance to transplant pediatric recipients with DCD livers due to concern over the medium to long-term outcome. We describe the outcome of 14 children (median age seven yr, 8 months-16 yr) that underwent LT with DCD grafts from July 2001 to December 2007. Donors had a median age of 23 yr (10-64), intensive care stay of five d (2-14) and bilirubin of 9 mmol/L (6-60). Median warm and cold ischemic time was 16 min (11-29) and seven h (5.5-8.4). Livers were transplanted as a whole organ (4), reduced graft (8), formal split (1) or auxiliary transplant (1). Compared to DBD recipients AST was significantly higher on the first three post-operative days and there was no difference in the INR, bilirubin or GGT out to 12 months. There were no biliary or vascular complications and patient and graft survival is 100% at a median follow-up of 41.8 months (1.7-74 months). LT with DCD grafts in pediatric recipients can be performed with low morbidity and excellent short-to-medium term patient and graft outcome.

Factors Affecting Graft Survival After Adult/Child Split-Liver Transplantation: Analysis of the UNOS/OPTN Data Base

When considering advocacy of split-liver transplantation, it is important to understand whether comparable outcomes can be achieved. The goal of this study was to identify donor and transplant characteristics predictive of comparable outcomes by risk factor analysis. Using the United Network for Organ Sharing/ Organ Procurement and Transplantation Network data base between January 1996 and May 2006, first time adult/child split cases (568 adults, 508 children) were examined. In multivariate analysis, recipient medical condition (hospitalization), status 1 assignment, ABO incompatibility, donor age (>40 years), donor body weight (< or = 40 kg), calculated whole graft volume to recipient body weight ratio (cGRWR < or = 1.5%) and no sharing between centers were significant risk factors in adult recipients. Recipient diagnosis of tumor, dialysis prior to transplant, recipient body weight (< or = 6 kg), donor age (>30 years), donor history of cardiac arrest after declaration of death and cold ischemia time (CIT > 6 h) increased the risk of graft failure in pediatric recipients. The livers from young donors showed comparable outcomes to whole deceased liver transplantation (LT) when other transplant-related risk factors were minimized in adult recipients. Reducing CIT is important to obtain comparable outcomes to living donor LT in pediatric recipients.

Results of 60 consecutive hepatectomies for pediatric living donor liver transplantation

Several technical improvements have been made to increase donor pool for pediatric liver transplantation, including reduced-size grafts, split-liver, and recently living donors. The objective of the present study is to report our single-center experience with 60 hepatectomies for living donor liver transplantation in pediatric recipients between June 2000 and December 2002. Donor workup consisted of a complete history and physical examination followed by laboratory test and liver function tests. Graft size was estimated using computed tomography scan or abdominal ultrasound. Liver biopsy was performed in all donors. Arteriogram was performed to evaluate hepatic arterial anatomy. All donors survived the procedure. Only seven patients experienced complications (10.2%), most of which were short term. We conclude that liver living donation for pediatric population is a safe procedure.

Application of living related auxiliary partial liver in an adult recipient with biliary atresia

Biliary atresia is the principal indication for liver transplantation in pediatric recipients. At Kyoto University, Japan, 210 patients with biliary atresia have undergone living related liver transplantation through April 1997, and 6 of these were in adult recipients. In living related liver transplantation the left lateral segment or left lobe of a living donor is used as the graft. When a partial liver graft is transplanted into a large recipient, its volume may be insufficient to provide life-sustaining hepatic reserve. At present, although use of a right lobe graft might provide up to double the functional mass of a left lobe graft, the additional risk to a healthy donor is generally not justifiable except in unusual circumstances.

Prevention of hepatic artery thrombosis in pediatric liver transplantation.

Hepatic artery thrombosis after orthotopic liver transplantation is a serious complication, especially in children. We report our experience with intensive anticoagulant therapy during and after living-related liver transplantation in pediatric recipients. Twenty-four patients between 5 months and 15 years of age were studied. The mean diameter of the anastomosed hepatic arteries was 2.7 mm. The anticoagulant therapy consisted of low-molecular-weight heparin, antithrombin III concentrates, prostaglandin E1, fresh frozen plasma, and a protease inhibitor. The profiles of the coagulation and fibrinolytic systems were monitored by measuring several parameters, including plasma levels of thrombin-antithrombin III complex, antithrombin III, plasmin-alpha 2 plasmin inhibitor complex, fibrin degradation product D-dimer, tissue type-plasminogen activator, and plasminogen activator inhibitor-1. Acceleration of the coagulation system and delayed recovery of the fibrinolytic system were observed during the early postoperative days. The plasma level of antithrombin III activity was maintained within the normal range by the administration of antithrombin III concentrates. None of the recipients developed hepatic artery thrombosis. Children have been reported to be at a greater risk of developing hepatic artery thrombosis than adults due to the small diameters of their hepatic arteries and the postoperative hypercoagulable state. We believe that the intensive anticoagulation therapy described in this study, the main concept of which is the early correction of imbalance between the coagulant and anticoagulant systems, could become a model for the prevention of hepatic artery thrombosis in pediatric liver transplantation patients.