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Koh ZJ, Wu AG, Yew A, Lee YY, Loh DL, Nyo YL, Mali VP. Systematic Review and Meta-Analysis of the Outcomes After Hepatic Artery Reconstruction in Pediatric Liver Transplantation Using a Microscope Versus Surgical Loupe. Transplant Proc 2024; 56:1585-1592. [PMID: 39164137 DOI: 10.1016/j.transproceed.2024.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 08/06/2024] [Indexed: 08/22/2024]
Abstract
BACKGROUND To review the impact of the operating microscope (OM) for reconstruction of the hepatic artery (HA) by comparing the outcomes with standard loupe reconstruction (SL) in pediatric liver transplantation (LT). METHODS Studies comparing the application of OM and SL for the reconstruction of the HA in primary pediatric LT were included from a systematic search of MEDLINE, Cochrane Library and EMBASE from inception to June 2022. Re-transplantation, dual grafts and auxiliary transplants were excluded. Primary outcome was the rate of HA thrombosis (HAT). Secondary outcomes were graft loss and mortality. RESULTS There were 1261 liver recipients from 9 included studies published until June 2022. There were 484 patients in the OM group and 777 patients in the SL group. HAT incidence with OM was significantly lower with OR = 0.18 (95% CI: 0.07-0.48). The 1-year graft survival was significantly better in the OM group with OR = 2.77 (95% CI: 1.13-6.80). 1-year overall mortality was also significantly lower with OM with OR = 0.39 (0.18-0.86). The use of OM did not significantly impact the incidence of HAT in the living donor liver transplant subgroup. Differences in time for hepatic HA reconstruction, total operating time and length of hospital stay did not reach statistical significance. CONCLUSION The use of OM has reduced the risk of HAT, graft loss and mortality in pediatric liver transplantation. Adoption of microsurgical principles in general may have contributed to the improved outcomes with SL reconstruction of HA in pediatric LT.
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Affiliation(s)
- Zong Jie Koh
- Department of Paediatric Surgery, National University Hospital, Singapore, Singapore.
| | - Andrew Gr Wu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ashley Yew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yang Yang Lee
- Department of Paediatric Surgery, National University Hospital, Singapore, Singapore
| | - Dale Lincoln Loh
- Department of Paediatric Surgery, National University Hospital, Singapore, Singapore
| | - Yoke Lin Nyo
- Department of Paediatric Surgery, National University Hospital, Singapore, Singapore
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2
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Maruszewski P, Vilchez Monge AL, Stefanowicz M, Szymczak M, Broniszczak D, Kowalski A, Kaliciński P, Ismail H. Does body weight below 6 kg modify survival of infants after liver transplant? Complete National Transplant Registry Data. J Pediatr Gastroenterol Nutr 2024; 79:636-643. [PMID: 39014874 DOI: 10.1002/jpn3.12320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE To determine the impact of infant recipient body weight at primary liver transplantation (LT) on both recipient and graft survival rates in complete national data from Poland. METHODS We conducted a single-center, retrospective cohort study including 142 LT recipients below 1 year of age with body weights below 10 kg who received primary and isolated LT between 2001 and 2017. Patients were divided into two study groups according to body weight at the time of LT: (1) Group I (≤6.0 kg, 32 patients) and (2) Group II (6.1-9.9 kg, 110 patients). Independent impact of body weight on patient and graft survival were assessed using survival curves and a multivariable Cox regression analysis. The univariate predictors of mortality or retransplantation at 1 year post-LT were recipient body weight of ≤6 kg at transplantation, pediatric end-stage liver disease score, urgent LT, graft from deceased donor, cold ischemia time, post-LT hepatic artery thrombosis, and post-LT dialysis. RESULTS No statistically significant impact of body weight ≤6 kg on 1-year failure-free survival was found based on the multivariable analysis (p = 0.063). Body weight ≤6 kg was associated with longer post-LT intensive care unit and post-LT hospital stays (p = 0.013 and 0.025, respectively). CONCLUSIONS Since no evidence of independent negative impact of recipient body weight ≤6 kg on failure-free survival 1 year post-LT was found, LT in infants with end-stage liver disease in Poland should be performed according to medical indications and urgency when an appropriate donor is available.
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Affiliation(s)
- Przemyslaw Maruszewski
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Almudena L Vilchez Monge
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marek Stefanowicz
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Marek Szymczak
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Dorota Broniszczak
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Adam Kowalski
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Piotr Kaliciński
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Hor Ismail
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
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3
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Lindner C, Riquelme R, San Martín R, Quezada F, Valenzuela J, Maureira JP, Einersen M. Improving the radiological diagnosis of hepatic artery thrombosis after liver transplantation: Current approaches and future challenges. World J Transplant 2024; 14:88938. [PMID: 38576750 PMCID: PMC10989478 DOI: 10.5500/wjt.v14.i1.88938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/03/2023] [Accepted: 12/29/2023] [Indexed: 03/15/2024] Open
Abstract
Hepatic artery thrombosis (HAT) is a devastating vascular complication following liver transplantation, requiring prompt diagnosis and rapid revascularization treatment to prevent graft loss. At present, imaging modalities such as ultrasound, computed tomography, and magnetic resonance play crucial roles in diagnosing HAT. Although imaging techniques have improved sensitivity and specificity for HAT diagnosis, they have limitations that hinder the timely diagnosis of this complication. In this sense, the emergence of artificial intelligence (AI) presents a transformative opportunity to address these diagnostic limitations. The develo pment of machine learning algorithms and deep neural networks has demon strated the potential to enhance the precision diagnosis of liver transplant com plications, enabling quicker and more accurate detection of HAT. This article examines the current landscape of imaging diagnostic techniques for HAT and explores the emerging role of AI in addressing future challenges in the diagnosis of HAT after liver transplant.
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Affiliation(s)
- Cristian Lindner
- Department of Radiology, Faculty of Medicine, University of Concepción, Concepción 4030000, Chile
- Department of Radiology, Hospital Clínico Regional Guillermo Grant Benavente, Concepción 4030000, Chile
| | - Raúl Riquelme
- Department of Radiology, Faculty of Medicine, University of Concepción, Concepción 4030000, Chile
- Department of Radiology, Hospital Clínico Regional Guillermo Grant Benavente, Concepción 4030000, Chile
| | - Rodrigo San Martín
- Department of Radiology, Faculty of Medicine, University of Concepción, Concepción 4030000, Chile
- Department of Radiology, Hospital Clínico Regional Guillermo Grant Benavente, Concepción 4030000, Chile
| | - Frank Quezada
- Department of Radiology, Faculty of Medicine, University of Concepción, Concepción 4030000, Chile
- Department of Radiology, Hospital Clínico Regional Guillermo Grant Benavente, Concepción 4030000, Chile
| | - Jorge Valenzuela
- Department of Radiology, Faculty of Medicine, University of Concepción, Concepción 4030000, Chile
- Department of Radiology, Hospital Clínico Regional Guillermo Grant Benavente, Concepción 4030000, Chile
| | - Juan P Maureira
- Department of Statistics, Catholic University of Maule, Talca 3460000, Chile
| | - Martín Einersen
- Department of Radiology, Faculty of Medicine, University of Concepción, Concepción 4030000, Chile
- Neurovascular Unit, Department of Radiology, Hospital Clínico Regional Guillermo Grant Benavente, Concepción 4030000, Chile
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4
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Martinez M, Kang E, Beltramo F, Nares M, Jeyapalan A, Alcamo A, Monde A, Ridall L, Kamath S, Betters K, Rowan C, Mangus RS, Kaushik S, Zinter M, Resch J, Maue D. Vascular thrombosis after pediatric liver transplantation: Is prevention achievable? JOURNAL OF LIVER TRANSPLANTATION 2023; 12:100185. [PMID: 38037556 PMCID: PMC10686788 DOI: 10.1016/j.liver.2023.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Background Vascular thromboses (VT) are life-threatening events after pediatric liver transplantation (LT). Single-center studies have identified risk factors for intra-abdominal VT, but large-scale pediatric studies are lacking. Methods This multicenter retrospective cohort study of isolated pediatric LT recipients assessed pre- and perioperative variables to determine VT risk factors and anticoagulation-associated bleeding complications. Results Within seven postoperative days, 31/331 (9.37%) patients developed intra-abdominal VT. Open fascia occurred more commonly in patients with VT (51.61 vs 23.33%) and remained the only independent risk factor in multivariable analysis (OR = 2.84, p = 0.012). Patients with VT received more blood products (83.87 vs 50.00%), had significantly higher rates of graft loss (22.58 vs 1.33%), infection (50.00 vs 20.60%), and unplanned return to the operating room (70.97 vs 16.44%) compared to those without VT. The risk of bleeding was similar (p = 0.2) between patients on and off anticoagulation. Conclusions Prophylactic anticoagulation did not increase bleeding complications in this cohort. The only independent factor associated with VT was open fascia, likely a graft/recipient size mismatch surrogate, supporting the need to improve surgical techniques to prevent VT that may not be modifiable with anticoagulation.
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Affiliation(s)
- Mercedes Martinez
- Columbia University Irving Medical Center, Department of Pediatrics, New York, USA
| | - Elise Kang
- Columbia University Irving Medical Center, Department of Pediatrics, New York, USA
| | - Fernando Beltramo
- Children’s Hospital of Los Angeles, Department of Anesthesiology Critical Care, Los Angeles, USA
| | - Michael Nares
- University of Miami Miller School of Medicine, Department of Pediatrics, Miami, USA
| | - Asumthia Jeyapalan
- University of Miami Miller School of Medicine, Department of Pediatrics, Miami, USA
| | - Alicia Alcamo
- Children’s Hospital of Philadelphia, Department of Critical Care Medicine, Philadelphia, USA
| | - Alexandra Monde
- Georgetown University Hospital, Department of Pediatrics, Washington DC, USA
| | - Leslie Ridall
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, USA
| | - Sameer Kamath
- Duke University, Department of Pediatrics, Durham, USA
| | | | - Courtney Rowan
- Indiana University School of Medicine, Department of Pediatrics, Indianapolis, USA
| | | | - Shubhi Kaushik
- Mount Sinai School of Medicine, Department of Pediatrics, New York, USA
- Children’s Hospital at Montefiore, New York, USA
| | - Matt Zinter
- University of California San Francisco, Department of Pediatrics, San Francisco, USA
| | - Joseph Resch
- University of Minnesota, Department of Pediatrics, Minneapolis, USA
| | - Danielle Maue
- Indiana University School of Medicine, Department of Pediatrics, Indianapolis, USA
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5
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Wang Z, Gao W, Dong C, Sun C, Wang K, Zhang W, Song Z, Qin H, Han C, Yang Y, Zhang F, Xu M, Zheng W, Shen Z. Outcome of split-liver transplantation from pediatric donors weighing 25 kg or less. Liver Transpl 2023; 29:58-66. [PMID: 35715984 DOI: 10.1002/lt.26530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 05/28/2022] [Accepted: 06/11/2022] [Indexed: 01/14/2023]
Abstract
The lower limit of body weight for "splitable" liver grafts remains unknown. To examine the outcome of split-liver transplantation (SLT) from pediatric donors ≤25 kg relative to conventional graft-type liver transplantation from deceased donors under corresponding conditions, a total of 158 patients who received primary liver transplantation, including 22 SLTs from donors ≤25 kg, 46 SLTs from donors >25 kg, 76 whole-liver transplantations, and 14 reduced-liver transplantations in donors ≤25 kg between January 2018 and December 2019, were included in the study. There was no significant difference in the complications, patient survival, and graft survival between each of the latter three groups and the SLT ≤25 kg group. Pediatric End-Stage Liver Disease (PELD) score was the independent predictor of graft loss (death or retransplantation). Graft weight was the independent predictor of hepatic artery thrombosis. SLT using well-selected pediatric donors ≤25 kg is an effective strategy to increase organ availability, especially for low-body-weight recipients, compared with conventional graft type from deceased donors under the condition of corresponding donor weight without increasing morbidity and mortality.
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Affiliation(s)
- Zhen Wang
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Wei Gao
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China.,Tianjin Key Laboratory of Organ Transplantation , Tianjin , China
| | - Chong Dong
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Chao Sun
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Kai Wang
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Wei Zhang
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Zhuolun Song
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Hong Qin
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Chao Han
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Yang Yang
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Fubo Zhang
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Min Xu
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Weiping Zheng
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Zhongyang Shen
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China.,Tianjin Key Laboratory of Organ Transplantation , Tianjin , China
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Antala S, Whitehead B, Godown J, Hall M, Banc‐Husu A, Alonso EM, Taylor SA. Neonates with acute liver failure have higher overall mortality but similar posttransplant outcomes as older infants. Liver Transpl 2023; 29:5-14. [PMID: 35751574 PMCID: PMC9790045 DOI: 10.1002/lt.26537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/18/2022] [Accepted: 06/02/2022] [Indexed: 01/14/2023]
Abstract
Neonatal acute liver failure (ALF) carries a high mortality rate; however, little data exist on its peritransplant hospital course. This project aimed to identify factors associated with outcomes in neonates with ALF using large multicenter databases. Patients with International Classification of Diseases, Ninth Revision/International Classification of Diseases, Tenth Revision codes for liver failure (2004-2018) from linked Pediatric Health Information System and Scientific Registry of Transplant Recipients databases were assigned to two groups: neonates aged ≤30 days or older infants aged 31-120 days at admission. Billing data were used to assign diagnoses and assess patient comorbidities (sepsis, extracorporeal membrane oxygenation, total parenteral nutrition, intensive care unit, and cardiac/renal/respiratory failure). Statistical analysis included Kaplan-Meier survival curve analysis and univariate and multivariate analyses with the Cox proportional hazards model. We identified 1807 neonates and 890 older infants. Neonates had significantly lower survival to 90 days ( p = 0.04) and a lower rate of liver transplantation (2.0% vs. 6.4%; p < 0.001). Common risk factors associated with death or transplant were present between groups: diagnosis, respiratory failure, cardiac failure, and renal failure. Among neonates versus older infants who received a transplant, there was no significant differences in posttransplant lengths of stay (median 38 vs. 32 days; p = 0.53), posttransplant mortality (15% vs. 11%; p = 0.66), or graft loss (9.7% vs. 8.1%; p = 0.82). We present the largest multicenter study on peritransplant outcomes in neonatal ALF and show similar risk factors for death or transplant in neonates compared with older infants. Despite lower transplantation rates, neonates demonstrate similar posttransplant outcomes as older infants. Further studies are needed to better risk stratify neonates eligible for transplant and improve outcomes.
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Affiliation(s)
- Swati Antala
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Bridget Whitehead
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Justin Godown
- Department of Pediatrics, Division of Pediatric Cardiology, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Anna Banc‐Husu
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Estella M. Alonso
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Sarah A. Taylor
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Li Z, Zhang W, Shen Y, Bai X, Liang T. Microsurgical replacement of the right hepatic artery with the donor superior mesenteric artery in cadaveric donor pediatric liver transplantation. Pediatr Surg Int 2022; 39:13. [PMID: 36441295 DOI: 10.1007/s00383-022-05281-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To present our experience of using the pediatric donor superior mesenteric artery (SMA) as the interpositioning vessel to reconstruct the hepatic artery in pediatric deceased donor liver transplantation. METHODS Pediatric patients who received pediatric deceased donor livers from December 2019 to June 2021 were enrolled. RESULTS A total of 43 pediatric recipients received pediatric deceased donor livers during the study period. Thirty-four (79.1%) pediatric donors had normal hepatic artery anatomy, while nine (20.9%) showed variant anatomies. The SMAs of the pediatric donors were interposed in the latter eight cases. The anastomosis between the donor distal SMA and the donor celiac trunk artery (CTA) was initially performed in the back-table period, after which the other anastomosis between the donor proximal SMA and recipient CHA was performed. Only one case showed HAT occurrence (incidence rate, 2.3%). However, no arterial complications occurred in pediatric recipients with donor grafts that showed the variation of RHA replacement from the SMA and had undergone usage of the donor's SMA as an interpositioning vessel. CONCLUSIONS In pediatric deceased donor liver transplantation, the use of SMA as an interpositioning medium can solve the problems related to a tiny caliber and anatomical variations of the donor hepatic artery.
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Affiliation(s)
- Zhiwei Li
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Liver Transplant Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Liver Transplant Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Shen
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Liver Transplant Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xueli Bai
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Liver Transplant Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tingbo Liang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. .,Liver Transplant Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. .,Zhejiang Provincial Key Laboratory of Pancreatic Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. .,Key Lab of Combined Multi-Organ Transplantation of the Ministry of Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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8
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Gad EH, Sallam AN, Soliman H, Ibrahim T, Salem TAH, Ali MAH, Al-Sayed Abd-same M, Ayoub I. Pediatric living donor liver transplantation (LDLT): Short- and long-term outcomes during sixteen years period at a single centre- A retrospective cohort study. Ann Med Surg (Lond) 2022; 79:103938. [PMID: 35860167 PMCID: PMC9289343 DOI: 10.1016/j.amsu.2022.103938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 02/05/2023] Open
Abstract
Background and objectives Pediatric living donor liver transplantation (LDLT) is an effective tool for managing pediatric patients with end-stage liver disease (ESLD) with good long-term graft and patient survival, especially after improvement in peri-operative care, surgical tools and techniques; however, the morbidity and mortality after such a procedure are still a challenging matter. The study aimed to analyze short-and long-term outcomes after pediatric LDLT in a single centre. Methods We retrospectively analyzed 67 pediatric patients who underwent LDLT in the period from April 2003 to July 2018. The overall male/female ratio was 40/27. Results Forty-one (61.2%) of patients had ≥1 early and/or late morbidities; the early (less than 3months) and late (≥3months) ones affected 36(53.7%) and 12(17.9%) of them respectively. The 16-year graft and patient survivals were 35(52.2%) while early and late mortalities were 23(34.3%) and 9(13.4%) respectively. Sepsis and chronic rejection were the most frequent causes of early and late mortalities respectively. Moreover, more packed RBCs transfusion units, bacterial infections, and pulmonary complications were independent predictors of poor patient survival. Conclusions More packed RBCs transfusion units intra-operatively, and post-liver transplant (LT) bacterial infection, sepsis, chronic rejection, as well as pulmonary complications had a negative insult on our patients' outcomes, so proper management of them is mandatory for improving outcomes after pediatric LDLT. More packed RBCs transfusion units intra-operatively had a negative insult on outcomes after paediatric LDLT. Bacterial infection and pulmonary complications led to poor outcomes after paediatric LDLT. Sepsis and chronic rejection led to post paediatric LDLT poor patient outcomes.
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Affiliation(s)
- Emad Hamdy Gad
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt
- Corresponding author..
| | - Ahmed Nabil Sallam
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt
| | - Hosam Soliman
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt
| | - Tarek Ibrahim
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt
| | | | | | | | - Islam Ayoub
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt
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9
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Oh SH, Jeong IS, Kim DY, Namgoong JM, Jhang WK, Park SJ, Jung DH, Moon DB, Song GW, Park GC, Ha TY, Ahn CS, Kim KH, Hwang S, Lee SG, Kim KM. Recent Improvement in Survival Outcomes and Reappraisal of Prognostic Factors in Pediatric Living Donor Liver Transplantation. Liver Transpl 2022; 28:1011-1023. [PMID: 34536963 DOI: 10.1002/lt.26308] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/02/2021] [Accepted: 09/10/2021] [Indexed: 12/16/2022]
Abstract
Living donor liver transplantation (LDLT) is a significant advancement for the treatment of children with end-stage liver disease given the shortage of deceased donors. The ultimate goal of pediatric LDLT is to achieve complete donor safety and zero recipient mortality. We conducted a retrospective, single-center assessment of the outcomes as well as the clinical factors that may influence graft and patient survival after primary LDLTs performed between 1994 and 2020. A Cox proportional hazards model was used for multivariate analyses. The trends for independent prognostic factors were analyzed according to the following treatment eras: 1, 1994 to 2002; 2, 2003 to 2011; and 3, 2012 to 2020. Primary LDLTs were performed on 287 children during the study period. Biliary atresia (BA; 52%), acute liver failure (ALF; 26%), and monogenic liver disease (11%) were the leading indications. There were 45 graft losses (16%) and 27 patient deaths (7%) in this population during the study period. During era 1 (n = 81), the cumulative survival rates at 1 and 5 years after LDLT were 90.1% and 81.5% for patients and 86.4% and 77.8% for grafts, respectively. During era 2 (n = 113), the corresponding rates were 92.9% and 92% for patients and 89.4% and 86.7% for grafts, respectively. During era 3 (n = 93), the corresponding rates were 100% and 98.6% for patients and 98.9% and 95.4% for grafts, respectively. In the multivariate analyses, primary diagnosis ALF, bloodstream infection, posttransplant lymphoproliferative disease, and chronic rejection were found to be negative prognostic indicators for patient survival. Based on generalized care guidelines and center-oriented experiences, comprehensive advances in appropriate donor selection, refinement of surgical techniques, and meticulous medical management may eventually realize a zero-mortality rate in pediatric LDLT.
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Affiliation(s)
- Seak Hee Oh
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - In Sook Jeong
- Department of Pediatrics, Mediplex Sejong Hospital, Incheon, Korea
| | - Dae Yeon Kim
- Division of Pediatric Surgery, Department of Surgery Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Man Namgoong
- Division of Pediatric Surgery, Department of Surgery Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Kyoung Jhang
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Jong Park
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hwan Jung
- Hepato-biliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok Bog Moon
- Hepato-biliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Won Song
- Hepato-biliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gil-Chun Park
- Hepato-biliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yong Ha
- Hepato-biliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chul-Soo Ahn
- Hepato-biliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Hun Kim
- Hepato-biliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Hepato-biliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Gyu Lee
- Hepato-biliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Mo Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
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10
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Nickel KJ, Morzycki A, Visser L, Bell E, Ladak A. Effect of magnification in pediatric liver transplantation: A systematic review and meta-analysis. Pediatr Transplant 2022; 26:e14223. [PMID: 35001466 DOI: 10.1111/petr.14223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 11/28/2021] [Accepted: 12/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hepatic artery thrombosis (HAT) represents a devastating and often fatal complication of liver transplantation. Due to the small vessel caliber in pediatric patients, the use of an operating microscope has largely become the standard for hepatic artery reconstruction to reduce the rate of HAT. Recent evidence, however, suggests that loupe magnification for anastomosis may be equally effective. We aimed to determine the effect of magnification on the rate of hepatic artery thrombosis in pediatric liver transplantation. METHODS A systematic search of the literature was conducted. Thousand eighty-eight unique titles were assessed by two independent reviewers. Studies directly comparing rates of HAT from loupe magnification and operating microscope-assisted anastomoses were eligible for meta-analysis. RESULTS Among primary transplants, the rate of HAT was 6.0%. Operating microscope anastomosis was associated with a 2.6% decrease in the rate of HAT compared to that of loupe magnification (4.9% and 7.4%, respectively, p < .040). When re-transplants were included, the rate of HAT was 5.8%. Operating microscope anastomosis was associated with a 1.0% decrease in the rate of HAT compared to that of loupe magnification (5.3% and 6.3%, respectively, p < .279). Meta-analysis of eligible studies demonstrated a reduction in the rate of HAT with the use of an operating microscope (p < .03). CONCLUSIONS Anastomosis under an operating microscope may be associated with decreased rates of HAT in children undergoing primary liver transplantation. Further high-quality studies comparing the two techniques are needed.
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Affiliation(s)
- Kevin J Nickel
- Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Alexander Morzycki
- Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Lloyd Visser
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Adil Ladak
- Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Alberta, Canada
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11
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Dalzell C, Vargas PA, Soltys K, Dipaola F, Mazariegos G, Oberholzer J, Goldaracena N. Living Donor Liver Transplantation vs. Split Liver Transplantation Using Left Lateral Segment Grafts in Pediatric Recipients: An Analysis of the UNOS Database. Transpl Int 2022; 36:10437. [PMID: 35391900 PMCID: PMC8980223 DOI: 10.3389/ti.2022.10437] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/03/2022] [Indexed: 12/12/2022]
Abstract
Split and LDLT in pediatric patients have the potential to decrease wait times and waitlist mortality. Using UNOS-STAR data, we compared outcomes of pediatric patients undergoing LDLT and SLT using LLS grafts. The baseline characteristics and post-operative outcomes were compared between groups. Actuarial graft and patient survival were analyzed with Kaplan-Meier curves. Between 2010 and 2019, 911 pediatric LT were included in the analysis (LD graft group, n = 508, split graft group, n = 403). LD graft recipients spent more time on the waitlist vs. the split graft group (60 (22–138) days vs. 46 (16–108) days; p = 0.007). LD recipients had a lower rate of graft failure, found in 9.8% of patients compared with 14.6% in the split graft group (p = 0.02). HAT was the most common graft failure cause, with similar rates. Graft and patient survival at 1-, 3-, and 5-years was comparable between LDLT and SLT. In subgroup analyses, patients with biliary atresia, those ≤10 kg or ≤10 years old receiving an LD graft showed improved graft survival. In conclusion, LDLT is associated with a lower rate of graft failure in pediatric patients. The use of LLS regardless of the type of donor is a safe way to facilitate access to transplantation to pediatric patients with acceptable short and long-term outcomes.
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Affiliation(s)
- Christina Dalzell
- School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Paola A Vargas
- Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Kyle Soltys
- Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA, United States.,Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh and Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Frank Dipaola
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Virginia, Charlottesville, VA, United States
| | - George Mazariegos
- Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA, United States.,Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh and Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Jose Oberholzer
- Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Nicolas Goldaracena
- Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA, United States
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12
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Nickel KJ, Staples J, Meeberg G, Kwan PO, Gilmour S, Bigam DL, Dajani K, Shapiro AMJ, Kneteman NM, Ladak A. The Transition to Microsurgical Technique for Hepatic Artery Reconstruction in Pediatric Liver Transplantation. Plast Reconstr Surg 2021; 148:248e-257e. [PMID: 34181598 DOI: 10.1097/prs.0000000000008169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Hepatic artery thrombosis represents a potentially fatal complication following liver transplantation. Rates of hepatic artery thrombosis are significantly higher in children, with mortality reported up to 80 percent. Microsurgical anastomosis has been shown to decrease the rate of hepatic artery thrombosis and now represents the standard of care at the authors' institution. In this article, the authors present the largest study of its type directly comparing rates of hepatic artery thrombosis with and without microsurgical reconstruction of the hepatic artery. METHODS All pediatric patients who underwent primary orthotopic liver transplantation between 1989 and 2018 were included. Patients were divided into two cohorts: standard anastomosis with loupes, and microsurgical anastomosis under the operating microscope. The authors' primary outcome was the rate of hepatic artery thrombosis. Secondary outcomes were graft survival, patient survival, retransplantation rate, requirement for intraoperative blood products, and length of stay. RESULTS Two hundred thirty-one children met criteria for inclusion. One hundred eighty cases were performed with loupe magnification and 51 cases were performed under the microscope. The hepatic artery thrombosis rate was lower, but not significantly so (p = 0.114), in the microsurgical group [n = 1 (2.0 percent)] compared with the standard cohort [n = 15 (8.3 percent)]. Survival analysis revealed a significant increase in graft survival with microsurgical anastomosis (p = 0.020), but not patient survival (p = 0.196). The retransplantation rate was significantly lower with microsurgical anastomosis (p = 0.021). CONCLUSIONS Microsurgical anastomosis was associated with a clinically important decrease in hepatic artery thrombosis compared with standard loupe anastomosis. The graft survival rate was significantly higher in the microsurgical cohort, with a reduced retransplantation rate at 1 year. On this basis, the authors recommend microsurgical hepatic artery anastomosis in cases of pediatric liver transplantation. . CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Kevin J Nickel
- From the Divisions of Plastic Surgery, General and Transplant Surgery, and Pediatric Gastroenterology, University of Alberta
| | - John Staples
- From the Divisions of Plastic Surgery, General and Transplant Surgery, and Pediatric Gastroenterology, University of Alberta
| | - Glenda Meeberg
- From the Divisions of Plastic Surgery, General and Transplant Surgery, and Pediatric Gastroenterology, University of Alberta
| | - Peter O Kwan
- From the Divisions of Plastic Surgery, General and Transplant Surgery, and Pediatric Gastroenterology, University of Alberta
| | - Susan Gilmour
- From the Divisions of Plastic Surgery, General and Transplant Surgery, and Pediatric Gastroenterology, University of Alberta
| | - David L Bigam
- From the Divisions of Plastic Surgery, General and Transplant Surgery, and Pediatric Gastroenterology, University of Alberta
| | - Khaled Dajani
- From the Divisions of Plastic Surgery, General and Transplant Surgery, and Pediatric Gastroenterology, University of Alberta
| | - A M James Shapiro
- From the Divisions of Plastic Surgery, General and Transplant Surgery, and Pediatric Gastroenterology, University of Alberta
| | - Norman M Kneteman
- From the Divisions of Plastic Surgery, General and Transplant Surgery, and Pediatric Gastroenterology, University of Alberta
| | - Adil Ladak
- From the Divisions of Plastic Surgery, General and Transplant Surgery, and Pediatric Gastroenterology, University of Alberta
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13
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Impact of Graft Size Matching on the Early Post-Transplant Complications and Patients Survival in Children after Living Donor Liver Transplantations. CHILDREN-BASEL 2021; 8:children8070579. [PMID: 34356558 PMCID: PMC8307631 DOI: 10.3390/children8070579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 06/30/2021] [Accepted: 07/03/2021] [Indexed: 01/10/2023]
Abstract
We aimed to assess the impact of the graft-recipient weight ratio (GRWR) on early post-transplant complications and patient survival rates in children after living donor liver transplantation (LDLT). We retrospectively analyzed 321 patients who underwent LDLT from 2004 to 2019. The recipients were categorized into four groups: 37 patients had a GRWR ≤ 1.5% (Group A), 196 patients had a GRWR > 1.5% and ≤3.5% (Group B), 73 patients had a GRWR > 3.5% and <5% (Group C) and 15 patients had a GRWR ≥ 5% (Group D). Incidence of early surgical complications including vascular complications, biliary complications, postoperative bleedings, gastrointestinal perforations and graft loss were comparable among groups with a different GRWR. Delayed abdominal wound closure was more common in patients with a GRWR > 3.5%. Recipients with a GRWR < 5% had a significantly better prognosis concerning patients and graft survival. Using grafts with a GRWR < 5% allows us to expand the donor pool and decrease the risk of mortality while on the waiting list, when patients at the time of transplantation have less advanced liver disease. LDLT with a GRWR ≥ 5% is related to a higher risk of poor outcome, and thus should be an option for treating selected patients when the risk of a delayed transplantation is high and access to deceased donors is limited.
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14
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Özen J, Beime J, Brinkert F, Fischer L, Herden U, Grabhorn E. Short- and long-term results of liver transplantation according to age at transplant: a single-center experience of 351 children. Transpl Int 2021; 34:1251-1260. [PMID: 33772883 DOI: 10.1111/tri.13872] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 01/05/2021] [Accepted: 03/16/2021] [Indexed: 01/12/2023]
Abstract
Pediatric liver transplantation (PLT) has very good results at experienced transplant centers. However, there is still an ongoing discussion about inferior outcomes, especially in young infants. The aim of this retrospective study was to evaluate outcomes of infants compared to older recipients in a single center over 20 years. We conducted a retrospective study of children who received liver transplants at our center between 1991 and 2011. Only patients without other limiting organ involvement were included and compared according to age. The inclusion criteria were fulfilled by 351 patients (173 vs. 178). The most common indication in both groups was biliary atresia (82.1% vs. 49.4%). The 1-, 5-, and 10-year patient survivals were 93.8%/91.8%/91.1% and 93%/90.8%/90.1%, and the graft survivals were 90.4%/83.5%/79.6% and 89.4%/81.8%/77.5%, respectively. Complications such as postoperative bleeding, biliary complications, or perfusion impairment occurred more often in infants. Leading indications for retransplantation (vascular complications/primary nonfunction) and leading causes of death (sepsis/multiorgan failure) were the same in both groups. Significant predictors for patient loss were decade of transplantation, retransplantation, postoperative bleeding, and infections for infants. Predictors for graft loss were bowel perforation, arterial thrombosis, and age >12 months. Children can have excellent results, independent of age at PLT.
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Affiliation(s)
- Julia Özen
- Department of Pediatrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Beime
- Department of Pediatrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Brinkert
- Department of Pediatrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Fischer
- Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Herden
- Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Enke Grabhorn
- Department of Pediatrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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15
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Hong SK, Yi NJ, Hong K, Han ES, Lee JM, Choi Y, Lee KW, Suh KS. Risk Factors Affecting Outcomes in Pediatric Liver Transplantation: A Real-World Single-Center Experience. Ann Transplant 2021; 26:e929145. [PMID: 34045429 PMCID: PMC8168285 DOI: 10.12659/aot.929145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Despite liver transplantation (LT) being the standard treatment for pediatric end-stage liver disease, complications often persist and can adversely affect the post-transplant outcomes. This study aimed to identify the risk factors affecting the outcomes in pediatric LT patients. Material/Methods Data from pediatric patients who underwent primary LT from March 1988 to December 2018 were retrospectively analyzed. Chronic liver disease was defined as an explanted liver showing fibrosis regardless of grade, cirrhosis, or any other underlying disease that may cause progressive liver injury leading to fibrosis or cirrhosis. Results A total of 255 pediatric patients underwent LT during the study period. Their 1-, 5-, and 10-year overall survival rates were 90.5%, 88.4%, and 87.8%, respectively. According to multivariate analysis, while liver disease without underlying chronic liver disease (P=0.024) and a pediatric end-stage liver disease (PELD) score ≥30 (P=0.036) were the only factors associated with worse survival, body weight <6 kg (P=0.050), whole-liver DDLT compared to LDLT (P=0.001), fulminant liver failure (P=0.008), and postoperative hepatic artery complications (P<0.001) were associated with worse graft survival. Liver disease without underlying chronic liver disease was the only factor independently associated with hepatic artery complications (P=0.003). Conclusions Greater caution is recommended in pediatric patients with liver disease unaccompanied by underlying chronic liver disease, high PELD score, or low body weight to improve survival after LT. Hepatic artery complication was the only surgical complication affecting the graft survival outcome, especially in patients having liver disease without underlying chronic liver disease.
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Affiliation(s)
- Suk Kyun Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kwangpyo Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Eui Soo Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeong-Moo Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
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16
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Kumaran V, Kapoor S, Sable S, Nath B, Varma V. The "W" Technique: A Safe and Reproducible Technique for Hepatic Artery Reconstruction in Living Donor Liver Transplantation. Ann Transplant 2021; 26:e926979. [PMID: 33510125 PMCID: PMC7852041 DOI: 10.12659/aot.926979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Reconstruction of the hepatic arterial inflow can be technically demanding in living donor liver transplantation, and thrombosis can result in graft loss and mortality. We describe the safe and reproducible “W” technique to reconstruct the hepatic artery and outcomes before and after adoption of the technique in a consecutive series of liver transplants at 2 high-volume living donor liver transplant centers. Material/Methods Prospectively collected data were analyzed to compare the outcomes before and after introduction of a standardized “W” technique for reconstruction of the hepatic artery in 2 high-volume living donor liver transplant programs. Results In a consecutive series of 675 liver transplants, of which 27 were deceased donor transplants and 648 were living donor transplants, 443 transplants were performed with a standard interrupted reconstruction of the hepatic artery under loupes. These transplants were performed by a single surgeon, with an incidence of hepatic artery thrombosis of 2%. After introduction of the “W” technique, despite the arterial reconstruction being done by several surgeons in the early part of their learning curve, the incidence of hepatic artery thrombosis decreased to 0.86% in the next 232 transplants. Conclusions The “W” technique is a simple, easy to learn and teach technique for reconstruction of the hepatic artery without the use of the operating microscope in living donor liver transplantation.
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Affiliation(s)
- Vinay Kumaran
- Department of Surgery (Transplant), Hume Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Sorabh Kapoor
- Department of Surgical Gastroenterology and Liver Transplant, Zydus Hospital, Ahmedabad, India
| | - Shailesh Sable
- Department of Liver Transplant and Hepatobiliary Surgery, Sahyadri Hospital, Pune, India
| | - Barun Nath
- Department of Liver Transplant and Hepatobiliary Surgery, Apollo Gleneagles Hospital, Kolkata, India
| | - Vibha Varma
- Department of Liver Transplant and Hepatobiliary Surgery, Max Hospitals, New Delhi, India
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17
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Ebel NH, Hsu EK, Dick AAS, Shaffer ML, Carlin K, Horslen SP. Decreased Incidence of Hepatic Artery Thrombosis in Pediatric Liver Transplantation Using Technical Variant Grafts: Report of the Society of Pediatric Liver Transplantation Experience. J Pediatr 2020; 226:195-201.e1. [PMID: 32585237 PMCID: PMC9380891 DOI: 10.1016/j.jpeds.2020.06.053] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/26/2020] [Accepted: 06/17/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate risk factors for hepatic artery thrombosis (HAT) and examine the long-term outcomes of graft and patient survival after HAT in pediatric recipients of liver transplantation. STUDY DESIGN Using multicenter data from the Society of Pediatric Liver Transplantation, Kaplan-Meier and Cox regression analyses were performed on first-time pediatric (aged <18 years) liver transplant recipients (n = 3801) in the US and Canada between 1995 and 2016. RESULTS Of children undergoing their first liver transplantation, 7.4% developed HAT within the first 90 days of transplantation and, of those who were retransplanted, 20.7% developed recurrent HAT. Prolonged warm ischemia times increased the odds of developing HAT (OR, 1.11; P = .02). Adolescents aged 11-17 years (OR, 0.53; P = .03) and recipients with split, reduced, or living donor grafts had decreased odds of HAT (OR, 0.59; P < .001 compared with whole grafts). Fifty percent of children who developed HAT developed graft failure within the first 90 days of transplantation (adjusted hazard ratio, 11.87; 95% CI, 9.02-15.62) and had a significantly higher post-transplant mortality within the first 90 days after transplantation (adjusted hazard ratio, 6.18; 95% CI, 4.01-9.53). CONCLUSIONS These data from an international registry demonstrate poorer long-term graft and patient survival in pediatric recipients whose post-transplant course is complicated by HAT. Notably, recipients of technical variant grafts had lower odds of HAT compared with whole liver grafts.
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Affiliation(s)
- Noelle H. Ebel
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Evelyn K. Hsu
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - André A. S. Dick
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | | | - Kristen Carlin
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Simon P. Horslen
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
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18
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Lu YG, Pan ZY, Zhang S, Lu YF, Zhang W, Wang L, Meng XY, Yu WF. Living Donor Liver Transplantation in Children: Perioperative Risk Factors and a Nomogram for Prediction of Survival. Transplantation 2020; 104:1619-1626. [PMID: 32732839 DOI: 10.1097/tp.0000000000003056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Living donor liver transplantation (LDLT) in children has achieved promising outcomes during the past few decades. However, it still poses various challenges. This study aimed to analyze perioperative risk factors for postoperative death in pediatric LDLT. METHODS We retrospectively analyzed medical records of pediatric patients who underwent LDLT surgery from January 1, 2014, to December 31, 2016, in our hospital. Predictors of mortality following LDLT were analyzed in 430 children. Cox regression and Kaplan-Meier curve analysis were used for covariates selection. A nomogram was developed to estimate overall survival probability. The performance of the nomogram was assessed using calibration curve, decision curve analysis, and time-dependent receiver operating characteristic curve. RESULTS Among the 430 patients in this cohort (median [interquartile range] age, 7 [6.10] mo; 189 [43.9%] female; 391 [90.9%] biliary atresia), the overall survival was 91.4% (95% confidence interval, 89.2-94.4), and most of the death events (36/37) happened within 6 months after the surgery. Multivariate analysis indicated that the Pediatric End-stage Liver Disease score, neutrophil lymphocyte ratio, graft-to-recipient weight ratio, and intraoperative norepinephrine infusion were independent prognostic factors. A novel nomogram was developed based on these prognostic factors. The C index for the final model was 0.764 (95% confidence interval, 0.701-0.819). Decision curve analysis and time-dependent receiver operating characteristic curve suggested that this novel nomogram performed well at predicting mortality of pediatric LDLT. CONCLUSIONS We identified several perioperative risk factors for mortality of pediatric LDLT. And the newly developed nomogram can be a convenient individualized tool in estimating the prognosis of pediatric LDLT.
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Affiliation(s)
- Yu-Gang Lu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi-Ying Pan
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Zhang
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ye-Feng Lu
- Department of Hepatic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Zhang
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
- Fudan University Library, Fudan University, Shanghai, China
| | - Long Wang
- Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Yan Meng
- Department of Anesthesiology, Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Wei-Feng Yu
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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19
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Kim YM, Kwak BJ, Shim DJ, Kwon YK, Yoon YC. In Situ Left Lateral Sectionectomy in Deceased Donor Liver Transplantation: Could This Be Another Solution for a Large-for-Size Graft? A Case Report. Transplant Proc 2019; 51:3116-3119. [PMID: 31587814 DOI: 10.1016/j.transproceed.2019.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/09/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Large-for-size (LFS) graft should be avoided when performing an adult deceased donor liver transplantation (DDLT) as it is associated with abdominal compartment syndrome, severe graft injury, and primary graft nonfunction. When inadvertently facing with LFS graft intraoperatively, the most commonly reported approach has been a surgical reduction of the right lobe despite its technical difficulty in addition to ongoing coagulopathy after graft reperfusion. We report a case where we performed a left lateral sectionectomy instead of a right lobe modification. CASE REPORT A 44-year-old 58.4 kg female patient was admitted with drug-induced acute hepatic failure and underwent an emergency DDLT. The donor was a 51-year-old 60.0 kg man. At the time of procurement, the liver was noted to be hypertrophic. The estimated graft/recipient weight ratio was 3.49%. After completing the vascular and bile duct anastomosis, the abdomen could not be closed due to its large graft size. Because of the hypertrophic left lateral lobe and ongoing coagulopathy, we decided to perform an in situ left lateral sectionectomy rather than right posterior sectionectomy or right hemihepatectomy. The next day, the liver function failed to improve, and the patient's blood pressure began to decline gradually. Computed tomography showed severe inferior vena cava (IVC) compression by the graft, and the patient underwent transjugular IVC stent placement. Soon after, the patient's blood pressure improved and liver function gradually normalized. The patient was discharged uneventfully on postoperative day 45. CONCLUSION Under specific conditions, in situ left lateral sectionectomy is a solution for unexpected LFS graft during DDLT.
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Affiliation(s)
- Yu Mi Kim
- Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bong Jun Kwak
- Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Jae Shim
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong Kyong Kwon
- Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Young Chul Yoon
- Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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20
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Takeda M, Sakamoto S, Uchida H, Yoshimura S, Shimizu S, Hirata Y, Fukuda A, Schlegel A, Kasahara M. Technical Considerations in Liver Transplantation for Biliary Atresia With Situs Inversus. Liver Transpl 2019; 25:1333-1341. [PMID: 31063622 DOI: 10.1002/lt.25484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/25/2019] [Indexed: 01/13/2023]
Abstract
In liver transplantation (LT) for biliary atresia (BA) with situs inversus (SI), the surgical procedure is technically challenging due to multiple anatomical variations. We evaluated the surgical procedures and the outcomes in our patients and in the previously reported patients undergoing LT for BA with SI. Between November 2005 and October 2018, 235 children underwent LT with an overall 10-year graft survival of 94.7%. Of these, 6 (2.6%) patients received LT for BA with SI. Living donor liver transplantation (LDLT) was applied in all patients. Vascular anomalies at our center included the absence of the inferior vena cava (IVC; n = 5), a preduodenal portal vein (PV; n = 4), and an aberrant hepatic artery (HA; n = 1). Hepatic vein (HV) outflow obstruction occurred in 1 patient with an absent IVC and necessitated repositioning of the graft immediately after LDLT. PV stenosis occurred in 1 patient with a preduodenal PV at 5 months after LDLT. The overall survival of our patients was 80.0% at 3 years. In the literature, 49 patients with LT for BA with SI were reviewed. The survival rate was 91.8%, and the vascular complications included HV outflow obstruction (2.0%), PV complications (10.2%), and HA thrombosis (4.1%). All PV complications occurred in LDLT patients with a preduodenal PV (5/23; 21.7%). In conclusion, the detailed assessment of the surgical procedures and the systematic literature review demonstrated excellent outcomes after LT for BA with SI. Liver recipients with a preduodenal PV are exposed to a higher risk for vascular complications after a very challenging LT procedure with overall good outcomes.
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Affiliation(s)
- Masahiro Takeda
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Seisuke Sakamoto
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Hajime Uchida
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Shohei Yoshimura
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Seiichi Shimizu
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yoshihiro Hirata
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Akinari Fukuda
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Andrea Schlegel
- The Liver Unit, Queen Elizabeth University Hospital, Birmingham, United Kingdom
| | - Mureo Kasahara
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
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21
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Flynn E, Huang JY, Hardikar W, Herd L, Hodgson A, Monagle P. Antithrombotic management and thrombosis rates in children post-liver transplantation: A case series and literature review. Pediatr Transplant 2019; 23:e13420. [PMID: 31012220 DOI: 10.1111/petr.13420] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/05/2019] [Accepted: 03/20/2019] [Indexed: 12/14/2022]
Abstract
Thrombosis is a major postoperative complication in pediatric liver transplantation. There is marked heterogeneity in prophylactic antithrombotic therapies used, without established guidelines. This review summarizes current worldwide incidence of thrombotic events and compares antithrombotic therapies in children post-liver transplant, with comparison to our institution's experience. Of the twenty-three articles with sufficient detail to compare antithrombotic regimens, the overall incidence of thrombosis ranged from 2.4% to 17.3%. Incidence of HAT ranged from 0% to 28.1%, of HVT from 0% to 4.7%, of PVT from 1.5% to 11.2%, and of IVC thrombosis from 0% to 2.8%. Re-transplantation due to thrombosis ranged from 0% to 4.8%. Prophylactic antithrombotic therapies varied between studies, and bleeding complications were infrequently reported. Since 2010, 96 children underwent 100 liver transplants at our institution with thrombosis incidence comparable to international literature (HAT 6%, PVT 5%, IVC 1%, and HVT 0%). Re-transplantation due to thrombosis occurred in 2% and major bleeding occurred in 10%. The prophylactic antithrombotic therapies used post-liver transplantation in children remain varied. Low rates of thrombosis have been reported with antiplatelet use both with and without anticoagulation. Standard definitions and consistent reporting of bleeding complications are required, in addition to thrombosis rates, so that true risk-benefit assessment of reported regimes can be understood.
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Affiliation(s)
- Elise Flynn
- Department of Clinical Hematology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Joanna Y Huang
- Department of Clinical Hematology, Royal Children's Hospital, Parkville, Victoria, Australia.,Hematology Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Winita Hardikar
- Department of Clinical Hematology, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Lauren Herd
- Department of Clinical Hematology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Alexandra Hodgson
- Department of Clinical Hematology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Paul Monagle
- Department of Clinical Hematology, Royal Children's Hospital, Parkville, Victoria, Australia.,Hematology Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia
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22
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Grimaldi C, di Francesco F, Chiusolo F, Angelico R, Monti L, Muiesan P, de Ville de Goyet J. Aggressive prevention and preemptive management of vascular complications after pediatric liver transplantation: A major impact on graft survival and long-term outcome. Pediatr Transplant 2018; 22:e13288. [PMID: 30171665 DOI: 10.1111/petr.13288] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/13/2018] [Accepted: 07/30/2018] [Indexed: 12/14/2022]
Abstract
Vascular complications are a major cause of patient and graft loss after LTs. The aim of this study was to evaluate the effect of a multimodal perioperative strategy aimed at reducing the incidence of vascular complications. A total of 126 first isolated LTs-performed between November 2008 and December 2015-were retrospectively analyzed. A minimum follow-up period of 24 months was analyzable for 124/126 patients (98.4%). The aggressive preemptive strategy consisted of identifying and immediately managing any problem and any abnormality in the vascular flow, in any of the hepatic vessels, and at any time after the liver graft revascularization. As a result, with a median follow-up of 57 months (3-112 months), not a single graft has been lost from vascular or biliary problems. The actuarial 8-year graft survival is 96.5%. These results have shown that a combination of technical attention, medical prevention, an early diagnosis, and rapid interventions reduced the negative impact of vascular problems on the outcome of both grafts and patients.
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Affiliation(s)
- Chiara Grimaldi
- Department of Pediatric Surgery and Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabrizio di Francesco
- Department of Pediatrics and Pediatric Transplantation, ISMETT, UPMC, Palermo, Italy
| | - Fabrizio Chiusolo
- Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Roberta Angelico
- Department of Pediatric Surgery and Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lidia Monti
- Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Muiesan
- The Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
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23
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Ayvazoglu Soy EH, Kirnap M, Yildirim S, Moray G, Haberal M. Incisional Hernia After Liver Transplant. EXP CLIN TRANSPLANT 2017; 15:185-189. [PMID: 28260464 DOI: 10.6002/ect.mesot2016.p65] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES An incisional hernia seriously burdens the quality of life after liver transplant. The incidence of incisional hernia after liver transplant is reported to be 4% to 20%. Here, we evaluated incisional hernias that occurred after adult liver transplant and incisional hernias intentionally made in infant liver transplant procedures. MATERIALS AND METHODS Between December 1988 and May 2016, we performed 536 liver transplant procedures in 515 patients. Demographic features, surgical outcomes, and predisposing factors were evaluated. RESULTS Of 452 liver transplant patients included, incisional hernias were diagnosed in 29 patients (6.4%; 7 pediatric, 22 adult). Most were males (77%) with Child-Pugh score C cirrhosis (62%), moderate/severe ascites (81%), and serum albumin levels <3.5 g/L (86%). Incisional hernia developed in 16 of 51 patients (31%) with wound infection. Twelve incisional hernias were seen in 40 recipients (30%) with body mass index ≥30 kg/m2. Eight of 45 patients (18%) with repeated surgery had incisional hernias. Five of 22 adult incisional hernias (23%) had primary fascia repair, and 17 (77%) were repaired with Prolene mesh graft (3 sublay, 14 onlay). No other complications and no hernia recurrence were shown during follow-up (range, 8-138 mo). Of 7 pediatric liver transplant patients with intentionally made incisional hernias during liver transplant, 5 patients had primary fascia repair and 2 patients had onlay mesh repair. No complications or recurrence were shown during follow-up (range, 12-60 mo). CONCLUSIONS Repeated surgery, postoperative wound infection, and obesity were found to be predisposing risk factors for incisional hernia development after liver transplant in adults. Abdomen closure in infant liver transplant with large-for-size grafts is a different area of discussion. Here, we suggest that an intentionally made incisional hernia with staged closure of the abdomen is safe and effective for graft and patient survival.
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24
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Allard MA, Lopes F, Frosio F, Golse N, Sa Cunha A, Cherqui D, Castaing D, Adam R, Vibert E. Extreme large-for-size syndrome after adult liver transplantation: A model for predicting a potentially lethal complication. Liver Transpl 2017; 23:1294-1304. [PMID: 28779555 DOI: 10.1002/lt.24835] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/14/2017] [Accepted: 07/09/2017] [Indexed: 02/07/2023]
Abstract
There is currently no tool available to predict extreme large-for-size (LFS) syndrome, a potentially disastrous complication after adult liver transplantation (LT). We aimed to identify the risk factors for extreme LFS and to build a simple predictive model. A cohort of consecutive patients who underwent LT with full grafts in a single institution was studied. The extreme LFS was defined by the impossibility to achieve direct fascial closure, even after delayed management, associated with early allograft dysfunction or nonfunction. Computed tomography scan-based measurements of the recipient were done at the lower extremity of the xiphoid. After 424 LTs for 394 patients, extreme LFS occurred in 10 (2.4%) cases. The 90-day mortality after extreme LFS was 40.0% versus 6.5% in other patients (P = 0.003). In the extreme LFS group, the male donor-female recipient combination was more often observed (80.0% versus 17.4%; P < 0.001). The graft weight (GW)/right anteroposterior (RAP) distance ratio was predictive of extreme LFS with the highest area under the curve (area under the curve, 0.95). The optimal cutoff was 100 (sensitivity, 100%; specificity, 88%). The other ratios based on height, weight, body mass index, body surface area, and standard liver volume exhibited lower predictive performance. The final multivariate model included the male donor-female recipient combination and the GW/RAP. When the GW to RAP ratio increases from 80, 100, to 120, the probability of extreme LFS was 2.6%, 9.6%, and 29.1% in the male donor-female recipient combination, and <1%, 1.2%, and 4.5% in other combinations. In conclusion, the GW/RAP ratio predicts extreme LFS and may be helpful to avoid futile refusal for morphological reasons or to anticipate situation at risk, especially in female recipients. Liver Transplantation 23 1294-1304 2017 AASLD.
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Affiliation(s)
- Marc-Antoine Allard
- Digestive Surgery and Liver Transplantation, Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France.,Université Paris-Sud, Orsay, France.,INSERM 935, Villejuif, France
| | - Felipe Lopes
- Digestive Surgery and Liver Transplantation, Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France
| | - Fabio Frosio
- Digestive Surgery and Liver Transplantation, Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France
| | - Nicolas Golse
- Digestive Surgery and Liver Transplantation, Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France.,Université Paris-Sud, Orsay, France
| | - Antonio Sa Cunha
- Digestive Surgery and Liver Transplantation, Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France.,Université Paris-Sud, Orsay, France
| | - Daniel Cherqui
- Digestive Surgery and Liver Transplantation, Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France.,Université Paris-Sud, Orsay, France.,INSERM 785, Paris, France
| | - Denis Castaing
- Digestive Surgery and Liver Transplantation, Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France.,Université Paris-Sud, Orsay, France.,INSERM 785, Paris, France
| | - René Adam
- Digestive Surgery and Liver Transplantation, Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France.,Université Paris-Sud, Orsay, France.,INSERM 935, Villejuif, France
| | - Eric Vibert
- Digestive Surgery and Liver Transplantation, Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France.,Université Paris-Sud, Orsay, France.,INSERM 785, Paris, France
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25
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Takano C, Ishige M, Ogawa E, Usui H, Kagawa R, Tajima G, Fujiki R, Fukao T, Mizuta K, Fuchigami T, Takahashi S. A case of classical maple syrup urine disease that was successfully managed by living donor liver transplantation. Pediatr Transplant 2017; 21. [PMID: 28612395 DOI: 10.1111/petr.12948] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2017] [Indexed: 11/28/2022]
Abstract
Classical MSUD is often fatal without appropriate medical interventions because of metabolic crisis. There are numerous reports suggesting the therapeutic potential of deceased donor liver transplantation for MSUD. However, the usefulness of LDLT for MSUD is unknown. We report a case of classical MSUD, which was successfully managed by LDLT from the patient's father at 1 year of age. Abnormal brain findings, which were cured with effective treatment, gradually disappeared after LDLT. The patient then developed normally. Findings from this case suggest the importance of LDLT for maintaining low leucine levels and subsequent normal neurological development. Although LDLT involves a modest surgical insult, LDLT with a related donor achieves acceptable leucine levels for life.
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Affiliation(s)
- Chika Takano
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Mika Ishige
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Erika Ogawa
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Hiromi Usui
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Reiko Kagawa
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Go Tajima
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan.,Division of Neonatal Screening, Research Institute, National Center for Child Health and Development, Tokyo, Japan
| | - Ryoji Fujiki
- Department of Technology Development, Kazusa DNA Research Institute, Chiba, Japan
| | - Toshiyuki Fukao
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Koichi Mizuta
- Transplant Surgery Division, Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - Tatsuo Fuchigami
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Shori Takahashi
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
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26
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Kasahara M, Sakamoto S, Sasaki K, Uchida H, Kitajima T, Shigeta T, Narumoto S, Hirata Y, Fukuda A. Living donor liver transplantation during the first 3 months of life. Liver Transpl 2017; 23:1051-1057. [PMID: 28220684 DOI: 10.1002/lt.24743] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/08/2017] [Accepted: 01/27/2017] [Indexed: 12/28/2022]
Abstract
Living donor liver transplantation (LDLT) is now an established technique for treating children with end-stage liver disease. Few data exist about liver transplantation (LT) for exclusively young infants, especially infants of <3 months of age. We report our single-center experience with 12 patients in which LDLT was performed during the first 3 months of life and compare the results with those of older infants who underwent LT. All of the patients were treated at the National Center of Child Health and Development, Tokyo, Japan. Between November 2005 to November 2016, 436 children underwent LT. Twelve of these patients underwent LT in the first 3 months of life (median age, 41 days; median weight, 4.0 kg). The indications for transplantation were fulminant hepatic failure (n = 11) and metabolic liver disease (n = 1). All the patients received the left lateral segment (LLS) in situ to mitigate the problem of graft-to-recipient size discrepancy. A reduced LLS graft was used in 11 patients and a segment 2 monosegment graft was used in 1 patient. We compared the results with those of infants who were 4-6 months of age (n = 67) and 7-12 months of age (n = 110) who were treated in the same study period. There were significant differences in the Pediatric End-Stage Liver Disease score and the conversion rate of tacrolimus to cyclosporine in younger infants. Furthermore, the incidence of biliary complications, bloodstream infection, and cytomegalovirus infection tended to be higher, whereas the incidence of acute cellular rejection tended to be lower in younger infants. The overall cumulative 10-year patient and graft survival rates in recipients of <3 months of age were both 90.9%. LDLT during the first 3 months of life appears to be a feasible option with excellent patient and graft survival. Liver Transplantation 23 1051-1057 2017 AASLD.
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Affiliation(s)
- Mureo Kasahara
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Seisuke Sakamoto
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kengo Sasaki
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Hajime Uchida
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Toshihiro Kitajima
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Takanobu Shigeta
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Soichi Narumoto
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yoshihiro Hirata
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Akinari Fukuda
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
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27
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Miyagi S, Kakizaki Y, Shimizu K, Miyazawa K, Nakanishi W, Hara Y, Tokodai K, Nakanishi C, Kamei T, Ohuchi N, Satomi S. Arterial and biliary complications after living donor liver transplantation: a single-center retrospective study and literature review. Surg Today 2017; 48:131-139. [PMID: 28439714 DOI: 10.1007/s00595-017-1515-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 03/05/2017] [Indexed: 12/12/2022]
Abstract
AIM The mortality of patients on the waiting list for deceased donor liver transplantation (DDLT) is high, especially in countries where donation rates are low. Thus, living donor liver transplantation (LDLT) is an attractive option. However, compared with DDLT, LDLT is associated with increased rates of arterial and biliary complications. We examined the rates of complications and risk factors following LDLT. METHODS We retrospectively investigated and compared the rates of complications of DDLT and LDLT in our institute. We also performed univariate and multivariate analyses to identify the independent risk factors for these complications. The complications and specific disadvantages of LDLT were reviewed and discussed. RESULTS The incidence rate of arterial complications in LDLT was 6.0%, compared with 3.2% (13/441) in DDLT. A multivariate analysis identified low body weight (P = 0.032) as the only independent risk factor for hepatic artery thrombosis. The rate of all biliary complications in LDLT was 17.3%, compared with 18.7% in DDLT. The risk factors for biliary stricture identified by the multivariate analysis were recurrent cholangitis and the number of bile ducts. The durations of hospital stay and overall survival rates were similar between the two groups. CONCLUSION Given the shortage of deceased donor organs, we believe that LDLT is acceptable in an attempt to meet demand.
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Affiliation(s)
- Shigehito Miyagi
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Department of Surgery, Upper Digestive and Vascular Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
| | - Yuta Kakizaki
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Department of Surgery, Upper Digestive and Vascular Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Kenji Shimizu
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Department of Surgery, Upper Digestive and Vascular Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Koji Miyazawa
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Department of Surgery, Upper Digestive and Vascular Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Wataru Nakanishi
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Department of Surgery, Upper Digestive and Vascular Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Yasuyuki Hara
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Department of Surgery, Upper Digestive and Vascular Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Kazuaki Tokodai
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Department of Surgery, Upper Digestive and Vascular Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Chikashi Nakanishi
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Department of Surgery, Upper Digestive and Vascular Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Takashi Kamei
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Department of Surgery, Upper Digestive and Vascular Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Noriaki Ohuchi
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Department of Surgery, Upper Digestive and Vascular Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Susumu Satomi
- Division of Transplantation, Reconstruction, and Endoscopic Surgery, Department of Surgery, Upper Digestive and Vascular Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
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28
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Neto JS, Fonseca EA, Cândido HL, Pugliese R, Feier FH, Kondo M, Azambuja RL, Chapchap P. Alternatives for vascular reconstruction in pediatric living donor liver transplantation. Pediatr Transplant 2016; 20:717-722. [PMID: 27174167 DOI: 10.1111/petr.12720] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 01/10/2023]
Abstract
Many publications discuss the various strategies for vascular reconstruction (VR) in pediatric LDLT. Having knowledge of alternative techniques is helpful in planning transplants. This article presents three case reports that illustrate some of the alternative techniques for HV, PV, and HA reconstruction in pediatric LDLT. It also reviews the available alternative strategies reported for VR in pediatric LDLT. In the first case, a 13-month-old girl presented a PRETEXT III HB with invasion of the retrohepatic vena cava. An LLS graft HV was anastomosed to a DD iliac vein graft and subsequently implanted in a "standard" fashion in the recipient. In the second case, a 44-month-old boy presented with multifocal HB and portomesenteric thrombosis and the portal inflow was done through a renoportal anastomosis. In the third case, a 22-month-old child with a failed Kasai procedure had extensive HA thrombosis. The HA reconstruction was performed with an interposition of the recipient's IMV graft. The use of alternative techniques for VR in pediatric LDLT is paramount to the success of such a complex procedure. Imaging studies can help transplant surgeons outline surgical strategies and define the best technique to be used in each case.
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Affiliation(s)
- Joao Seda Neto
- Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Eduardo A Fonseca
- Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Helry L Cândido
- Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Renata Pugliese
- Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Flavia H Feier
- Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Mario Kondo
- Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,A.C. Camargo Cancer Center, São Paulo, Brazil
| | | | - Paulo Chapchap
- Hepatology and Liver Transplantation Unit, Hospital Sírio-Libanês, São Paulo, Brazil
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29
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Sanada Y, Hishikawa S, Okada N, Yamada N, Katano T, Hirata Y, Ihara Y, Urahashi T, Mizuta K. Dorsal approach plus branch patch technique is the preferred method for liver transplanting small babies with monosegmental grafts. Langenbecks Arch Surg 2016; 402:123-133. [PMID: 27456678 DOI: 10.1007/s00423-016-1479-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 07/12/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE When living donor liver transplantation (LDLT) is performed on small infant patients, the incidence of hepatic artery complications (HACs) is high. Here, we present a retrospective analysis that focuses on our surgical procedure for hepatic arterial reconstruction and the outcomes of monosegmental LDLT. METHODS Of the 275 patients who underwent LDLT between May 2001 and December 2015, 13 patients (4.7 %) underwent monosegmental LDLT. Hepatic artery reconstruction was performed under a microscope. The size discrepancy between the graft and the recipient's abdominal cavity was defined as the graft to recipient distance ratio (GRDR) between the left hepatic vein and the portal vein (PV) bifurcation on a preoperative computed tomography scan. HACs were defined as hepatic arterial hypoperfusion. RESULTS Recipient hepatic arteries were selected for the branch patch technique in five cases (38.5 %), and the diameter was 2.2 ± 0.6 mm. The anastomotic approaches selected were the dorsal position of the PV in seven cases (53.8 %) and the ventral position in six, and the GRDRs were 2.8 ± 0.4 and 1.9 ± 0.5, respectively (p = 0.012). The incidence rate of HACs caused by external factors, such as compression or inflammation around the anastomotic site, was significantly higher in monosegmental than in non-monosegmental graft recipients (15.4 vs. 1.1 %, p < 0.001). CONCLUSION Although monosegmental graft recipients experienced HACs caused by external factors around the anastomotic field, hepatic arterial reconstruction could be safely performed. Important components of successful hepatic arterial reconstructions include the employment of the branch patch technique and the selection of the dorsal approach.
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Affiliation(s)
- Yukihiro Sanada
- Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan.
| | - Shuji Hishikawa
- Center for Development of Advanced Medical Technology, Jichi Medical University, Shimotsuke City, Japan
| | - Noriki Okada
- Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan
| | - Naoya Yamada
- Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan
| | - Takumi Katano
- Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan
| | - Yuta Hirata
- Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan
| | - Yoshiyuki Ihara
- Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan
| | - Taizen Urahashi
- Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan
| | - Koichi Mizuta
- Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan
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30
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EXP CLIN TRANSPLANTExp Clin Transplant 2015; 13. [DOI: 10.6002/ect.mesot2014.o57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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31
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Chung PHY, Chan SC, Mok VWK, Tam PKH, Lo CM. Recipient body size does not matter in pediatric liver transplantation. J Pediatr Surg 2014; 49:1734-7. [PMID: 25487472 DOI: 10.1016/j.jpedsurg.2014.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 09/05/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND PURPOSE It is controversial whether small size recipient is associated with adverse outcome in liver transplantation. This study aims to evaluate the outcomes of pediatric liver transplantation according to body weight of recipients. METHODS Liver transplant recipients (age <18years, from 1993 to 2011) were studied retrospectively. They were categorized according to the body size at the time of transplantation (A: <6kg; B: between 6kg to 10kg; C: >10kg). RESULTS A total of 113 patients (83 LDLTs and 30 DDLTs) were studied. Thirteen (11.5%) belonged to group A, 56 (49.6%) belonged to group B, and 44 (38.9%) belonged to group C. The best graft and patient survivals were found in group A (Figs. 1 and 2), and none of the patients required re-laparotomy for general surgical complications, while 32 patients (32%) in groups B and C did. Regarding transplant-related complications, although group A patients had the highest incidence of biliary tract complications (38.5%, n=5), the incidence of vascular complications (hepatic artery: 7%, portal vein: 0%, hepatic vein: 0%) in this group was the lowest among the three groups. CONCLUSION Outcomes of small-sized recipients are not inferior. Less technical-related vascular complications, which may lead to early graft loss, were observed. This could be patient-related (less advanced cirrhosis) or surgeon-related (additional attention paid).
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Affiliation(s)
- Patrick Ho Yu Chung
- Division of Paediatric Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - See Ching Chan
- Division of Liver Transplantation, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Vivian Way Kay Mok
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Paul Kwong Hang Tam
- Division of Paediatric Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Chung Mau Lo
- Division of Liver Transplantation, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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Neto JS, Fonseca EA, Feier FH, Pugliese R, Candido HL, Benavides MR, Porta G, Miura IK, Danesi VB, Guimaraes T, Porta A, Borges C, Godoy A, Kondo M, Chapchap P. Analysis of factors associated with portal vein thrombosis in pediatric living donor liver transplant recipients. Liver Transpl 2014; 20:1157-67. [PMID: 24954288 DOI: 10.1002/lt.23934] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 06/02/2014] [Indexed: 02/07/2023]
Abstract
The technique of vascular reconstruction plays a major role in the outcome of living donor liver transplantation (LDLT). An increased use of vascular grafts (VGs) as replacements for sclerotic portal veins has become a standard technique for our group. The aim of this study was to analyze the factors associated with portal vein thrombosis (PVT) in pediatric LDLT. We performed a retrospective analysis of 486 primary pediatric LDLT procedures performed between October 1995 and May 2013. VGs used for portal reconstruction included living donor inferior mesenteric veins, living donor ovarian veins, recipient internal jugular veins, deceased donor iliac arteries, and deceased donor iliac veins. Thirty-four patients (7.0%) developed PVT. The incidence of PVT dropped from 10.1% to 2%; the overall utilization of VGs increased from 3.5% to 37.1%. In a multivariate analysis, only the use of VGs remained an independent risk factor for the occurrence of PVT (hazard ratio = 7.2, 95% confidence interval = 2.8-18.7, P < 0.001). There was no difference in survival rates between patients with PVT and patients without PVT. No patient with PVT underwent retransplantation. In conclusion, the use of VGs was independently associated with the development of PVT. Over time, there was a reduction in the incidence of early PVT in this cohort, and there was a trend toward a reduction in total PVT. The occurrence of isolated PVT in this study was not associated with decreased patient or graft survival.
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Affiliation(s)
- Joao Seda Neto
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, São Paulo, Brazil; A. C. Camargo Cancer Center, São Paulo, Brazil
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Mukerji AN, Karachristos A, Maloo M, Johnson D, Jain A. Do postliver transplant patients need thromboprophylactic anticoagulation? Clin Appl Thromb Hemost 2014; 20:673-7. [PMID: 24917126 DOI: 10.1177/1076029614538490] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Postoperative thromboprophylactic anticoagulation against Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) is standard of care with current evidence-based guidelines. However, majority of liver transplant (LT) patients have thrombocytopenia and/or prolonged INR before surgery. Studies or guidelines regarding role of prophylactic anticoagulation after LT are lacking. There is a need to balance the risk of thrombosis with significant hemorrhage, implying those needing transfusion or return to OR due to bleeding. We conclude that after LT, anticoagulation is not required routinely for DVT/PE prophylaxis. Rather, it is indicated in specific circumstances, chiefly for prophylaxis of hepatic artery thrombosis or portal vein thrombosis in cases with use of grafts, pediatric cases, small size vessels, Budd Chiari syndrome, amongst others.
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Affiliation(s)
- Amar Nath Mukerji
- Department of Surgery, Division of Abdominal Organ Transplant, Liver Transplant Program, Temple University Hospital, Philadelphia, PA, USA
| | - Andreas Karachristos
- Department of Surgery, Division of Abdominal Organ Transplant, Liver Transplant Program, Temple University Hospital, Philadelphia, PA, USA
| | - Manoj Maloo
- Department of Surgery, Division of Abdominal Organ Transplant, Liver Transplant Program, Temple University Hospital, Philadelphia, PA, USA
| | - David Johnson
- Department of Pharmacy, Temple University Hospital, Philadelphia, PA, USA
| | - Ashokkumar Jain
- Department of Surgery, Division of Abdominal Organ Transplant, Liver Transplant Program, Temple University Hospital, Philadelphia, PA, USA
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Indolfi G, Bèrczes R, Pelliccioli I, Bosisio M, Agostinis C, Resti M, Zambelli M, Lucianetti A, Colledan M, D'Antiga L. Neonatal haemochromatosis with reversible pituitary involvement. Transpl Int 2014; 27:e76-9. [PMID: 24725070 DOI: 10.1111/tri.12336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 03/16/2014] [Accepted: 04/07/2014] [Indexed: 11/30/2022]
Abstract
Neonatal haemochromatosis is a rare alloimmune gestational disease with a high mortality. The hallmark of neonatal haemochromatosis is severe neonatal liver failure associated with extrahepatic siderosis. Thus far, no pituitary dysfunction has been reported to result from the tissue damage associated with extrahepatic siderosis. The present report describes a neonate with neonatal haemochromatosis and secondary hypothyroidism associated with pituitary iron deposition. Both the conditions were successfully treated by ABO-incompatible liver transplantation. Pituitary gland dysfunction is another possible extrahepatic manifestation of neonatal haemochromatosis, and it is reversible after liver transplantation.
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Miyagi S, Nakanishi W, Kawagishi N, Yoshida H, Unno M, Ohuchi N. The effects of endothelial cells-preserving technique on microsurgical vascular reconstruction in biliary tract malignancy: report of twenty cases. Case Rep Gastroenterol 2014; 8:18-25. [PMID: 24574945 PMCID: PMC3934773 DOI: 10.1159/000358192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
We describe our experience of resectional surgery with microsurgical reconstruction of the hepatic arteries in 20 cases with biliary tract malignancy. Hepatic artery thrombosis (HAT) is a lethal complication; therefore, it is important to perform microsurgical reconstruction safely. Recently, we adopted the back wall support suture technique with double needle sutures that does not require the damaged short arteries to be turned over. In this technique, each stitch is placed from the inner side to the outer side to keep endothelial cells. The purpose of this study was to develop safety methods. From 2003 to 2012, 20 patients with biliary tract malignancy with possible involvement of the hepatic arteries underwent resectional surgery with microvascular reconstruction (cholangiocarcinoma: n = 15; others: n = 5). For this cohort study, patients were divided into two groups: group I (n = 5) included patients who underwent the conventional ‘twist technique’ and group II (n = 15) included patients who underwent the microsurgical back wall support suture technique with double needle sutures and received gabexate mesilate, a strong serine protease inhibitor (40 mg/kg/day) for 7 days. We investigated HAT using Doppler ultrasonography for 10 days. No postoperative mortality was observed. The incidence of HAT was only one case in group I, and there was no significant difference between the two groups. However, the value of the pulsatile index and acceleration time were significantly improved in group II. In conclusion, the back wall support suture technique with gabexate mesilate administration during microvascular reconstruction was found to be safe. It is important to keep endothelial cells healthy for microvascular reconstruction.
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Affiliation(s)
- Shigehito Miyagi
- Division of Transplantation, Reconstruction and Endoscopic Surgery, Sendai, Japan
| | - Wataru Nakanishi
- Division of Transplantation, Reconstruction and Endoscopic Surgery, Sendai, Japan
| | - Naoki Kawagishi
- Division of Transplantation, Reconstruction and Endoscopic Surgery, Sendai, Japan
| | - Hiroshi Yoshida
- Division of Digestive Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiaki Unno
- Division of Digestive Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriaki Ohuchi
- Division of Transplantation, Reconstruction and Endoscopic Surgery, Sendai, Japan
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Sanada Y, Wakiya T, Hishikawa S, Hirata Y, Yamada N, Okada N, Ihara Y, Urahashi T, Mizuta K, Kobayashi E. Risk factors and treatments for hepatic arterial complications in pediatric living donor liver transplantation. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 21:463-72. [PMID: 24142418 DOI: 10.1002/jhbp.49] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Hepatic artery complications (HAC) are a serious complication in pediatric liver transplant recipients because its incidence is high and it can occasionally lead to graft liver failure. We herein present a retrospective analysis of our 10-year experience with pediatric living donor liver transplantation (LDLT) focusing on the risk factors and treatments for HAC. METHODS Between May 2001 and November 2011, 209 LDLTs were performed for 203 pediatric recipients. We performed the multivariate analyses to identify the factors associated with HAC and showed the therapeutic strategy and outcome for HAC. RESULTS The overall incidence of HAC was 7.2%, and the graft survival of recipients with HAC was 73.3%. The multivariate analysis showed that the pediatric end-stage liver disease score (≥20), post-transplant laparotomy except for HAC treatment and extra-anatomical hepatic artery reconstruction were independent risk factors for HAC (P = 0.020, P = 0.015 and P = 0.002, respectively). Eleven surgical interventions and 13 endovascular interventions were performed for 15 recipients with HAC. The serum aspartate aminotransferase levels pre- and post-treatment for HAC were significantly higher in the surgical group than in the endovascular group (P = 0.016 and P = 0.022, respectively). CONCLUSIONS It is important for recipients with risk factors to maintain strict post-transplant management to help prevent HAC and detect it in earlier stages. Endovascular intervention can be a less invasive method for treating HAC than surgical intervention, and can be performed as an early treatment.
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Affiliation(s)
- Yukihiro Sanada
- Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
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Wakiya T, Sanada Y, Mizuta K, Urahashi T, Ihara Y, Yamada N, Okada N, Egami S, Nakata M, Hakamada K, Yasuda Y. A comparison of open surgery and endovascular intervention for hepatic artery complications after pediatric liver transplantation. Transplant Proc 2013; 45:323-9. [PMID: 23375320 DOI: 10.1016/j.transproceed.2012.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 07/25/2012] [Accepted: 08/08/2012] [Indexed: 12/13/2022]
Abstract
There are currently 2 major therapeutic options for the treatment of hepatic artery complications: endovascular intervention and open surgery. We herein report a retrospective analysis of 14 pediatric patients with hepatic artery complications after pediatric living donor liver transplantation (LDLT) at our institution. We divided them into an open surgery group and an endovascular intervention group based on their primary treatment, and compared the results and outcomes. We then evaluated which procedure is more effective and less invasive. In the open surgery group, recurrent stenosis or spasm of the hepatic artery occurred in 3 of the 8 patients (37.5%). In the endovascular intervention group, 5 of the 6 patients were technically successfully treated by only endovascular treatment. Of the 5 successfully treated patients, 3 developed recurrent stenosis (60%). There were significant differences in the mean length of the operation for the first treatment of hepatic artery complications (open surgery, 428 minutes vs endovascular intervention, 160 minutes; P = .01) and in the mean value of the posttreatment aspartate aminotransferase (AST)/alanine aminotransferase (ALT) (open surgery > endovascular intervention; P = .04/.05). Although endovascular intervention needs to be examined in further studies to reduce the rate of relapse, it is a less invasive method for the patient and graft than open surgery.
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Affiliation(s)
- T Wakiya
- Department of Transplant Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
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38
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Miyagi S, Kawagishi N, Satoh K, Sekiguchi S, Ohuchi N, Satomi S. A patient with hepatic artery thrombosis after living-donor liver transplantation survived the great East Japan earthquake 3 days after reoperation: a case report. Transplant Proc 2013; 45:2066-8. [PMID: 23769110 DOI: 10.1016/j.transproceed.2012.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 11/20/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND On March 11, 2011, our hospital was severely damaged by the Great East Japan Earthquake. We report the rare case of a 5-month-old patient with hepatic artery thrombosis (HAT) after living donor liver transplantation (LDLT), who survived the earthquake that occurred 3 days after the reoperation; we were able to save this patient without abilities to perform blood tests or computed tomography (CT) for 4 days. METHODS This female infant with biliary atresia underwent LDLT 5 months after birth and developed peritonitis owing to perforation of the small intestine 7 days later. Her blood pressure decreased and she developed HAT. We performed emergency reconstruction of the hepatic artery and repair of the small intestine, and 3 days after surgery, the Great East Japan Earthquake occurred. RESULTS We could not perform blood tests or CT scans because the water supply was damaged. Gas supply lines were also damaged and sterilization was not possible; surgical tools were limited. However, emergency power was available, so we performed ultrasonography every 6 hours and predicted liver function from intrahepatic blood flow and monitored for Glisson's capsule edema. The blood examination system recovered 14 days after LDLT, and we confirmed improvement of liver function. The patient was extubated 37 days after LDLT and discharged on postoperative day 67. CONCLUSIONS Portable ultrasonography was useful in evaluating intrahepatic blood flow and Glisson's capsule edema. Furthermore, it was effective during a disaster because it required no water or gas.
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Affiliation(s)
- S Miyagi
- Division of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University, Sendai, Japan.
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39
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Miyagi S, Kawagishi N, Nakanishi W, Fujio A, Miyazawa K, Maida K, Kashiwadate T, Hara Y, Sekiguchi S, Ohuchi N, Satomi S. Risk Factors for Hepatic Artery Thrombosis After Microsurgical Vascular Reconstruction in Liver Transplantation. Transplant Proc 2013; 45:1994-6. [DOI: 10.1016/j.transproceed.2012.12.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 11/22/2012] [Accepted: 12/31/2012] [Indexed: 01/27/2023]
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40
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Levesque E, Duclos J, Ciacio O, Adam R, Castaing D, Vibert E. Influence of larger graft weight to recipient weight on the post-liver transplantation course. Clin Transplant 2013; 27:239-47. [PMID: 23293941 DOI: 10.1111/ctr.12059] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 12/26/2022]
Abstract
Size matching between recipient and donor livers is an important factor in organ allocation in the context of liver transplantation (LT). The aim of this study was to determine whether a large graft for recipient size influenced the post-transplant course. One hundred and sixty-two successive LT recipients were included and retrospectively divided into two groups: 25 (15%) had a graft-to-recipient weight ratio (GWRW) ≥ 2.5% and 137 (85%) had a GWRW <2.5%. Postoperative complications and outcomes were recorded. In the GWRW >2.5% group, more end-to-end caval replacement (72% vs. 38%, p = 0.003) and veno-venous bypass (48% vs. 23%, p = 0.01) were used. Peak AST/ALT values were higher in the GWRW >2.5% group (AST: 596 [70-5876] vs. 453 [29-5132] IU/l, p = 0.03; ALT: 773 [101-5025] vs. 383 [36-4921] IU/l, p = 0.02). Among postoperative complications, the rate of respiratory failure was higher in the GWRW >2.5% group (32% vs. 14%, p = 0.04). The rates of other complications did not differ between the two groups. Both groups had similar graft and patient survival rates at one yr. Using large grafts for recipient size did not impair liver function and did not modify graft and patient outcomes at one yr. However, a GWRW >2.5% appeared to be a determining factor for respiratory morbidity following LT.
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Affiliation(s)
- Eric Levesque
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.
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Hori T, Kaido T, Tamaki N, Toshimitsu Y, Ogawa K, Uemoto S. An adult with primary hyperoxaluria type 1 regrets not receiving preemptive liver transplantation during childhood: report of a case. Surg Today 2012; 43:1185-7. [DOI: 10.1007/s00595-012-0310-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 05/13/2012] [Indexed: 10/28/2022]
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Mali V, Aw M, Quak S, Loh D, Prabhakaran K. Vascular Complications in Pediatric Liver Transplantation; Single-Center Experience from Singapore. Transplant Proc 2012; 44:1373-8. [DOI: 10.1016/j.transproceed.2012.01.129] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 01/18/2012] [Indexed: 01/10/2023]
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Wakiya T, Sanada Y, Mizuta K, Egami S, Hishikawa S, Nakata M, Hakamada K, Yasuda Y, Kawarasaki H. Interventional radiology for hepatic artery complications soon after living donor liver transplantation in a neonate. Pediatr Transplant 2012; 16:E81-5. [PMID: 21199209 DOI: 10.1111/j.1399-3046.2010.01441.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Early hepatic artery complications after liver transplantation in children, having undergone LDLT, can directly affect graft and recipient outcomes, making early diagnosis and treatment essential. In the past, laparotomy (thrombectomy or reanastomosis) was generally employed to treat early hepatic artery complications. Recently, favorable outcomes of IR have been reported. In children, however, the number of such reports is small. To the best of our knowledge, there is no published report on IR applied to neonates with early hepatic artery complications. We recently succeeded in safely using IR for a neonate with early hepatic artery complications after LDLT and obtained a favorable outcome. This case is presented herein.
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Affiliation(s)
- T Wakiya
- Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
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Mori A, Kaido T, Ogura Y, Ogawa K, Hata K, Yagi S, Yoshizawa A, Isoda H, Shibata T, Uemoto S. Standard hepatic vein reconstruction with patch plasty using the native portal vein in adult living donor liver transplantation. Liver Transpl 2012; 18:602-7. [PMID: 22253117 DOI: 10.1002/lt.23387] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
An outflow obstruction of the hepatic vein is a critical complication after living donor liver transplantation (LDLT) and occasionally leads to hepatic failure. Here we introduce a simple method for preventing outflow obstructions by patch plasty in adult LDLT. Between September 2001 and May 2010, 468 adult LDLT procedures were performed at Kyoto University Hospital. We harvested each recipient's portal vein (PV) from the extirpated liver for a patch. We intended to re-form several orifices of the hepatic veins into a single, large orifice. The patch was attached to the anterior wall of the re-formed orifice on the bench. After we put in the liver graft, the procedure for the hepatic vein anastomosis to the inferior vena cava was simple enough that the warm ischemia time was reduced. Three of the 468 cases were diagnosed with an outflow obstruction. All 3 cases underwent hepatic vein reconstruction without patch plasty. In contrast, none of the 159 cases that underwent LDLT with patch plasty suffered from an outflow obstruction, regardless of the liver graft type. The procedure for hepatic vein plasty using a patch from the native PV is simple and elegant and results in excellent outcomes. We propose this as the standard procedure for hepatic vein reconstruction in adult LDLT.
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Affiliation(s)
- Akira Mori
- Department of Surgery (Division of Hepato-Biliary-Pancreatic Surgery and Transplantation)Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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45
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Lin TL, Chiang LW, Chen CL, Wang SH, Lin CC, Liu YW, Yong CC, Lin TS, Li WF, Jawan B, Cheng YF, Chen TY, Concejero AM, Wang CC. Intra-operative management of low portal vein flow in pediatric living donor liver transplantation. Transpl Int 2012; 25:586-91. [PMID: 22448749 DOI: 10.1111/j.1432-2277.2012.01464.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
For pediatric living donor liver transplantation, portal vein complications cause significant morbidity and graft failure. Routine intra-operative Doppler ultrasound is performed after graft reperfusion to evaluate the flow of portal vein. This retrospective study reviewed 65 children who had undergone living donor liver transplantation. Seven patients were detected with suboptimal portal vein flow velocity following vascular reconstruction and abdominal closure. They underwent immediate on-table interventions to improve the portal vein flow. Both surgical and endovascular modalities were employed, namely, graft re-positioning, collateral shunt ligation, thrombectomy, revision of anastomosis, inferior mesenteric vein cannulation, and endovascular stenting. The ultrasonographic follow-up assessment for all seven patients demonstrated patent portal vein and satisfactory flow. We reviewed our experience on the different modalities and proposed an approach for our future intra-operative management to improve portal vein flow at the time of liver transplantation.
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Affiliation(s)
- Ting-Lung Lin
- Liver Transplantation Program, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Gelas T, McKiernan PJ, Kelly DA, Mayer DA, Mirza DF, Sharif K. ABO-incompatible pediatric liver transplantation in very small recipients: Birmingham's experience. Pediatr Transplant 2011; 15:706-11. [PMID: 21762327 DOI: 10.1111/j.1399-3046.2011.01541.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Liver transplantation (LT) for very small recipients is challenging but in experienced centres, good results can be achieved. Despite the risk of antibody-mediated acute rejection, some studies have demonstrated the safety of ABO incompatible liver transplantation (ILT) in children and particularly in infants. The aim of our study was to describe the outcome of liver transplantation in infants <5 kg and the safety of using ILT in this group. All LT performed between 1991 and 2010 in children <5 kg were reviewed. Twenty-nine patients were included, five of whom had an ILT. Acute liver failure was encountered in 20 cases. The recipient age and weight at transplantation were respectively 63 days (range: 14-268 days) and 4 kg (range: 2.4-5 kg). The graft-to-recipient ratio was 6.1% (range 2.3-9%). An aortic conduit and delayed abdominal closure were used respectively in 76% and 81% of the procedures. The ABO compatible liver transplantation (CLT) and ILT groups were similar regarding recipient's demographics, graft types or technical transplantation data. The one- and five-yr patient and graft survival were respectively 62%, 62% and 62%, 57.9% with a median follow-up of 95 months. Vascular complications occurred in six cases (21.4%) and biliary complications were encountered in five patients (17%). Acute and chronic rejection developed respectively in 37% and 26% of the recipients. The five patients undergoing ILT are all alive without graft lost after a median follow-up of 34 months (range 7-55 months). When compared with the CLT group, no significant differences were found regarding patient or graft survival, vascular or biliary complications and rejection rates. In our experience, ILT in small infants has short and long term outcomes comparable to ABO-compatible grafts and excellent results can be achieved with a standard immunosuppressive protocol. To avoid mortality on the waiting list for neonatal recipients, ABO-incompatible liver grafts can be used safely.
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Affiliation(s)
- Thomas Gelas
- Liver Unit, Birmingham Children's Hospital, Birmingham, UK.
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47
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48
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Lee KJ, Choi ST, Min C, Lee JN, Lee WK, Baek JH, Kim KK, Kang JM, Lee WS. Hepatic Arterial Complications after Liver Transplantation: A Single-Center Experience. KOREAN JOURNAL OF TRANSPLANTATION 2011. [DOI: 10.4285/jkstn.2011.25.3.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Keun Jeong Lee
- Department of Surgery, Gacheon University Gil Hospital, Incheon, Korea
| | - Sang Tae Choi
- Department of Surgery, Gacheon University Gil Hospital, Incheon, Korea
| | - Chung Min
- Department of Surgery, Gacheon University Gil Hospital, Incheon, Korea
| | - Jung Nam Lee
- Department of Surgery, Gacheon University Gil Hospital, Incheon, Korea
| | - Woon Ki Lee
- Department of Surgery, Gacheon University Gil Hospital, Incheon, Korea
| | - Jeong-Heum Baek
- Department of Surgery, Gacheon University Gil Hospital, Incheon, Korea
| | - Keon Kuk Kim
- Department of Surgery, Gacheon University Gil Hospital, Incheon, Korea
| | - Jin Mo Kang
- Department of Surgery, Gacheon University Gil Hospital, Incheon, Korea
| | - Won Suk Lee
- Department of Surgery, Gacheon University Gil Hospital, Incheon, Korea
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Wakiya T, Sanada Y, Mizuta K, Umehara M, Urahashi T, Egami S, Hishikawa S, Nakata M, Hakamada K, Yasuda Y, Kawarasaki H. Endovascular interventions for hepatic artery complications immediately after pediatric liver transplantation. Transpl Int 2011; 24:984-90. [DOI: 10.1111/j.1432-2277.2011.01298.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Vascular complications after living donor liver transplantation: a Brazilian, single-center experience. Transplant Proc 2011; 43:196-8. [PMID: 21335187 DOI: 10.1016/j.transproceed.2010.12.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In living donor liver transplantation (LDLT), vascular complications are more frequently seen than in deceased donor transplantation. Early arterial, portal vein, or hepatic vein thromboses are complications that can lead to graft loss and patient death. The aim of this study was to assess the incidence, treatment, and outcome of vascular complications after LDLT in a single Brazilian center. METHODS Between December 2001 and December 2010, we performed 130 LDLT. Sixty-four recipients were children (27 weighing <10 kg). RESULTS Nine recipients had vascular complications. Hepatic artery thrombosis (HAT) occurred in 4 (3.1%), portal vein thrombosis (PVT) in 3 (2.3%), and hepatic vein thrombosis (HVT) and hepatic arterial stenosis (HAS) in 1 (0.8%) patient each. Complications were identified by Doppler and confirmed by angiography or angiotomography. Patients with HAT were listed for retransplantation. One died before retransplant. Two children were submitted to retransplantation; one is still alive, with neurologic sequelae. One adult with HAT was retransplanted with a deceased donor graft and is doing well 58 months after surgery. Two patients with PVT died as a consequence of graft malfunction. In the other case, portal vein arterialization was performed, but patient died 11 months posttransplant. HVT was detected after cardiac reanimation and was treated with an endovascular stent. This patient died 3 months after LDLT. HAS was diagnosed after liver abscess development and was successfully treated by endovascular angioplasty. No recurrence was observed after 22 months. Follow-up ranged from 9 to 117 months. CONCLUSION Pediatric patients are more prone to develop vascular complications after LDLT. Long-term survival was statistically lower for recipients with vascular complications (33.3% vs 77.7%; P = .008).
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