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Dong C, Song Z, Sun C, Wang K, Zhang W, Chen J, Zheng W, Yang Y, Wang Z, Han C, Jiao L, Zhang G, Xie E, Gao W, Shen Z. Basiliximab Induction and Postoperative Steroid-free Immunosuppression With Tacrolimus in Pediatric Liver Transplantation: A Randomized Clinical Trial. Transplantation 2024; 108:1769-1775. [PMID: 38419149 DOI: 10.1097/tp.0000000000004951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Optimizing the immunosuppressive regimen is essential to improve the long-term outcomes of pediatric liver transplant recipients. METHODS We conducted a prospective, randomized, open-label study to compare the safety and efficacy of 2 treatment approaches during pediatric liver transplantation: tacrolimus monotherapy following basiliximab induction (the study group) and a dual regimen of tacrolimus plus steroids (the control group). A total of 150 patients were enrolled, with 75 patients allocated to each group. RESULTS In both groups, recipients achieved graft and recipient overall survival rates exceeding 93%, with no statistically significant differences between them. However, the study group exhibited a significantly lower incidence of acute cellular rejection (ACR), delayed occurrence of ACR, and an improved ACR-free survival rate at 2 y compared with the control group. Notably, the study group also showed a significant reduction in the incidence of de novo donor-specific antibodies at 3-mo and 2-y posttransplant. Furthermore, 6 mo after the transplant, the study group demonstrated significant improvements in weight-for-age Z score and height-for-age Z score. No notable differences were observed in postoperative complications or the incidence of liver fibrosis between the 2 groups. CONCLUSIONS Basiliximab induction combine with tacrolimus (TAC) monotherapy is a safe and effective immunosuppressive regimen to reduce the episodes of ACR without influencing the development of liver fibrosis and graft and recipient survival rate after pediatric liver transplantation.
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Affiliation(s)
- Chong Dong
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Zhuolun Song
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Chao Sun
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Kai Wang
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Wei Zhang
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Jing Chen
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Weiping Zheng
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Yang Yang
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Zhen Wang
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Chao Han
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Lijun Jiao
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Guofeng Zhang
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Enbo Xie
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Wei Gao
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Zhongyang Shen
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
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2
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Hakeem AR, Gee H, Attia M, Raj Prasad K. Gastric sleeve as an extra-anatomical roux for biliary reconstruction in a pediatric third liver transplant. Pediatr Transplant 2024; 28:e14769. [PMID: 38659292 DOI: 10.1111/petr.14769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Sir Roy Calne in 1976 described "Biliary reconstruction is the Achilles heel of liver transplantation," and it remains true. In some patients, such as those with short-gut syndrome and concomitant biliary atresia, neither duct to duct nor Roux biliary reconstruction is feasible. METHODS We present a case of child's third liver transplant (LT), where an innovative extra-anatomical biliary bypass was created using a sleeve from greater curvature of the stomach. RESULTS The patient is well nearly 10 years following the LT. CONCLUSIONS This technique could prove to be an important addition to the armamentarium of a surgeon in difficult retransplants and in patients with short-gut syndrome as it provides a viable option with good long-term outcome.
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Affiliation(s)
- Abdul Rahman Hakeem
- Department of Hepatobiliary and Liver Transplant Surgery, St James's University Hospital NHS Trust, Leeds, UK
| | - Harrison Gee
- Department of Hepatobiliary and Liver Transplant Surgery, St James's University Hospital NHS Trust, Leeds, UK
| | - Magdy Attia
- Department of Hepatobiliary and Liver Transplant Surgery, St James's University Hospital NHS Trust, Leeds, UK
| | - K Raj Prasad
- Department of Hepatobiliary and Liver Transplant Surgery, St James's University Hospital NHS Trust, Leeds, UK
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3
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Naeem B, Ayub A, Coss-Bu J, Mian MUM, Hernaez R, Fogarty TP, Deshotels K, Kennedy C, Goss J, Desai MS. Postoperative outcomes of acute-on-chronic liver failure in infants and children with biliary atresia. Pediatr Transplant 2024; 28:e14736. [PMID: 38602219 DOI: 10.1111/petr.14736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/02/2024] [Accepted: 02/20/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Acute-on-chronic liver failure (ACLF) is associated with increased mortality and morbidity in patients with biliary atresia (BA). Data on impact of ACLF on postoperative outcomes, however, are sparse. METHOD We performed a retrospective analysis of patients with BA aged <18 years who underwent LT between 2011 and 2021 at our institution. ACLF was defined using the pediatric ACLF criteria: ≥1 extra-hepatic organ failure in children with decompensated cirrhosis. RESULTS Of 107 patients (65% female; median age 14 [9-31] months) who received a LT, 13 (12%) had ACLF during the index admission prior to LT. Two (15%) had Grade 1; 4 (30%) had Grade 2; and 7 (55%) had Grade ≥3 ACLF. ACLF cohort was younger at time of listing (5 [4-8] vs. 9 [6-24] months; p < .001) and at LT (8 [8-11] vs. 16 [10-40] months, p < .001) compared to no-ACLF group. Intraoperatively, ACLF patients had higher blood loss (40 [20-53] vs. 10 [6-19] mL/kg; p < .001) and blood transfusion requirements (33 [21-69] vs. 18 [7-25] mL/kg; p = .004). Postoperatively, they needed higher vasopressor support (31% vs. 10.6%; p = .04) and had higher total hospital length of stay (106 [45-151] vs. 13 [7-30] days; p = .023). Rate of return to the operating room, hospital readmission rates, and 1-year post-LT survival rates were comparable between the groups. CONCLUSION Despite higher perioperative complications, survival outcomes for ACLF in BA after LT are favorable and comparable to those without ACLF. These encouraging data reiterate prioritization during organ allocation of these critically ill children for LT.
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Affiliation(s)
- Buria Naeem
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Adil Ayub
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jorge Coss-Bu
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Muhammad Umair M Mian
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Ruben Hernaez
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Section of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Baylor College of Medicine, Houston, Texas, USA
| | - Thomas P Fogarty
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Kirby Deshotels
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Curt Kennedy
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - John Goss
- Division of Abdominal Transplantation and Hepatobiliary Surgery, Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Moreshwar S Desai
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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Sakamoto S, Shimizu S, Uchida H, Fukuda A, Kasahara M. Portal vein pressure and flow modulation in pediatric liver transplantation. Pediatr Transplant 2023; 27:e14563. [PMID: 37470148 DOI: 10.1111/petr.14563] [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] [Received: 04/29/2023] [Accepted: 06/23/2023] [Indexed: 07/21/2023]
Abstract
Liver transplantation (LT) has been indicated for smaller and more clinically severe patients in recent years. Small biliary atresia (BA) patients often show portal hypoplasia and sclerotic portal vein (PV), which may make PV reconstruction more difficult during the operation. Among PV complications, intraoperative PV thrombosis can be considered a disaster, and it is important to prevent this catastrophic event by the precise assessment of the PV structure and PVF using radiological imaging before and during LT. However, there are no objective parameters to indicate whether sufficient PVF can be obtained. PV pressure (PVP) and PV flow (PVF) have mainly been studied in adult living donor LT, for the purpose of preventing small-for-size syndrome, and PVP has been considered an objective parameter of graft inflow modulation (GIM). In the setting of pediatric LT, GIM is mainly performed to prevent hypoperfusion, and it must be performed before graft implantation. GIM to maximize the PVF of pediatric patients with potentially low PVF in LT consists of the interruption of collateral vessels, the assessment of the usability of the native PV, and technical modifications in PV reconstruction. Reliable objective parameters that represent sufficient PVF before graft implantation are desired. Our recent study proposed that a PVP of ≥25 mmHg before graft implantation can be considered an objective parameter to obtain sufficient PVF (cutoff value: 50 mL/min/100 g of graft weight). Further investigation is needed to determine the best strategy for successful PV reconstruction in pediatric LT.
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Affiliation(s)
- Seisuke Sakamoto
- 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
| | - Hajime Uchida
- 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
| | - Mureo Kasahara
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
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5
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Hartleif S, Hodson J, Lloyd C, Cousin VL, Czubkowski P, D'Antiga L, Debray D, Demetris A, Di Giorgio A, Evans HM, Fischler B, Gonzales E, Gouw ASH, Hübscher SG, Jacquemin E, Lacaille F, Malenicka S, McLin VA, Markiewicz-Kijewska M, Mazariegos GV, Rajanayagam JK, Scheenstra R, Singer S, Smets F, Sokal E, Squires JE, Sturm E, Verkade H, Kelly DA. Long-term Outcome of Asymptomatic Patients With Graft Fibrosis in Protocol Biopsies After Pediatric Liver Transplantation. Transplantation 2023; 107:2394-2405. [PMID: 37143195 DOI: 10.1097/tp.0000000000004603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND The histological prevalence of allograft fibrosis in asymptomatic children after liver transplantation (LT) is well documented. However, long-term graft and patient survival remain unclear. This retrospective multicenter study aims to determine the prevalence of allograft fibrosis and analyze the long-term outcome for patients transplanted in childhood. METHODS We reviewed clinical data of children who had undergone 10-y protocol liver biopsies. We excluded patients with autoimmune hepatitis, primary sclerosing cholangitis, hepatitis B or C, and retransplantation. In total, 494 patients transplanted in childhood across 12 international transplant centers were included. We evaluated the development of fibrosis by comparing the results with biopsies obtained 5 and 15 y post-LT. Histological findings were correlated with graft and patient survival up to 20 y post-LT. RESULTS In the 10-y biopsies, periportal or pericentral fibrosis was observed in 253 patients (51%), 87 (18%) had bridging fibrosis, 30 (6%) had cirrhosis, and 124 (25%) had no fibrosis. The prevalence and stage of graft fibrosis significantly progressed from 5 to 10 y. At 10 y, the severity of fibrosis correlated significantly with inflammation. Patients with graft cirrhosis in the 10-y biopsy were more likely to die or require retransplantation subsequently ( P = 0.027). CONCLUSIONS At 10 y post-LT, most patients transplanted in childhood developed fibrosis, based on the protocol liver biopsies. Although mild-to-moderate graft fibrosis did not largely affect patient or graft survival up to 20 y post-LT, this progressive fibrosis finding has substantial implications for developing cirrhosis and portal hypertension in adult care.
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Affiliation(s)
- Steffen Hartleif
- Pediatric Gastroenterology and Hepatology, University Hospital Tübingen, Tübingen, Germany
| | - James Hodson
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Translational Medicine, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Carla Lloyd
- Liver Unit, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
| | - Vladimir L Cousin
- Swiss Pediatric Liver Centre, Division of Pediatric Specialties, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals Geneva and University of Geneva, Geneva, Switzerland
| | - Piotr Czubkowski
- Department of Liver Disorders and Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Lorenzo D'Antiga
- Pediatric Hepatology, Gastroenterology and Transplantation, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Dominique Debray
- Pediatric Liver Unit, National Reference Centre for Rare Pediatric Liver Diseases (Biliary Atresia and Genetic Cholestasis), FILFOIE, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Anthony Demetris
- Division of Liver and Transplantation Pathology, Department of Pathology, University of Pittsburgh, Pittsburgh, PA
| | - Angelo Di Giorgio
- Pediatric Hepatology, Gastroenterology and Transplantation, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Helen M Evans
- Department of Pediatric Gastroenterology, Starship Child Health, University of Auckland, Auckland, New Zealand
| | - Björn Fischler
- Pediatric Digestive Diseases, Astrid Lindgren Children's Hospital, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Emmanuel Gonzales
- Hépatologie et Transplantation Hépatique Pédiatriques, Centre de référence de l'atrésie des voies biliaires et des cholestases génétiques, FSMR FILFOIE, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Kremlin-Bicêtre, France
| | - Annette S H Gouw
- Department of Pathology and Medical Biology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Stefan G Hübscher
- Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Emmanuel Jacquemin
- Hépatologie et Transplantation Hépatique Pédiatriques, Centre de référence de l'atrésie des voies biliaires et des cholestases génétiques, FSMR FILFOIE, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Kremlin-Bicêtre, France
| | - Florence Lacaille
- Pediatric Liver Unit, National Reference Centre for Rare Pediatric Liver Diseases (Biliary Atresia and Genetic Cholestasis), FILFOIE, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Silvia Malenicka
- Pediatric Digestive Diseases, Astrid Lindgren Children's Hospital, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Valerie A McLin
- Swiss Pediatric Liver Centre, Division of Pediatric Specialties, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals Geneva and University of Geneva, Geneva, Switzerland
| | | | - George V Mazariegos
- Department of Surgery, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Jeremy K Rajanayagam
- Paediatric Gastroenterology, Hepatology and Nutrition, The Royal Children's Hospital, Melbourne, Australia
| | - René Scheenstra
- Pediatric Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan Singer
- Institute of Pathology, University Hospital Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies," University of Tübingen, Tübingen, Germany
| | - Françoise Smets
- UClouvain, Clinical and Experimental Research Institute and Cliniques Universitaires Saint Luc, Service de Gastroentérologie Hépatologie Pédiatrique, Brussels, Belgium
| | - Etienne Sokal
- UClouvain, Clinical and Experimental Research Institute and Cliniques Universitaires Saint Luc, Service de Gastroentérologie Hépatologie Pédiatrique, Brussels, Belgium
| | - James E Squires
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Ekkehard Sturm
- Pediatric Gastroenterology and Hepatology, University Hospital Tübingen, Tübingen, Germany
| | - Henkjan Verkade
- Pediatric Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Deirdre A Kelly
- Liver Unit, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
- University of Birmingham, Birmingham, United Kingdom
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Rodriguez-Davalos MI, Lopez-Verdugo F, Kasahara M, Muiesan P, Reddy MS, Flores-Huidobro Martinez A, Xia Q, Hong JC, Niemann CU, Seda-Neto J, Miloh TA, Yi NJ, Mazariegos GV, Ng VL, Esquivel CO, Lerut J, Rela M. International Liver Transplantation Society Global Census: First Look at Pediatric Liver Transplantation Activity Around the World. Transplantation 2023; 107:2087-2097. [PMID: 37750781 DOI: 10.1097/tp.0000000000004644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Over 16 000 children under the age of 15 died worldwide in 2017 because of liver disease. Pediatric liver transplantation (PLT) is currently the standard of care for these patients. The aim of this study is to describe global PLT activity and identify variations between regions. METHODS A survey was conducted from May 2018 to August 2019 to determine the current state of PLT. Transplant centers were categorized into quintile categories according to the year they performed their first PLT. Countries were classified according to gross national income per capita. RESULTS One hundred eight programs from 38 countries were included (68% response rate). 10 619 PLTs were performed within the last 5 y. High-income countries performed 4992 (46.4%) PLT, followed by upper-middle- (4704 [44·3%]) and lower-middle (993 [9·4%])-income countries. The most frequently used type of grafts worldwide are living donor grafts. A higher proportion of lower-middle-income countries (68·7%) performed ≥25 living donor liver transplants over the last 5 y compared to high-income countries (36%; P = 0.019). A greater proportion of programs from high-income countries have performed ≥25 whole liver transplants (52.4% versus 6.2%; P = 0.001) and ≥25 split/reduced liver transplants (53.2% versus 6.2%; P < 0.001) compared to lower-middle-income countries. CONCLUSIONS This study represents, to our knowledge, the most geographically comprehensive report on PLT activity and a first step toward global collaboration and data sharing for the greater good of children with liver disease; it is imperative that these centers share the lead in PLT.
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Affiliation(s)
- Manuel I Rodriguez-Davalos
- Liver Transplant Unit, Intermountain Primary Children's Hospital and the Center for Global Surgery, University of Utah, Salt Lake City, UT
| | - Fidel Lopez-Verdugo
- Liver Transplant Unit, Intermountain Primary Children's Hospital and the Center for Global Surgery, University of Utah, Salt Lake City, UT
- School of Medicine, Tecnologico de Monterrey, Mexico City, Mexico
| | - Mureo Kasahara
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Paolo Muiesan
- Liver Unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Mettu S Reddy
- The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, and Bharath Institute of Higher Education and Research, Chennai, India
| | - Angel Flores-Huidobro Martinez
- Liver Transplant Unit, Intermountain Primary Children's Hospital and the Center for Global Surgery, University of Utah, Salt Lake City, UT
- School of Medicine, Universidad Anahuac, Mexico City, Mexico
| | - Qiang Xia
- Department of Liver Surgery and Liver Transplantation, Renji Hospital, Shanghai, People's Republic of China
| | - Johnny C Hong
- Division of Transplant Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Claus U Niemann
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Joao Seda-Neto
- Department of Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | - Tamir A Miloh
- Miami Transplant Institute, University of Miami, Miami, FL
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - George V Mazariegos
- Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Vicky L Ng
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, and Transplant and Regenerative Medicine Center, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Canada
| | - Carlos O Esquivel
- Department of Abdominal Transplantation, Stanford University Medical Center, Palo Alto, CA
| | - Jan Lerut
- Institute for Experimental and Clinical Research, Université Catholique Louvain, Brussels, Belgium
| | - Mohamed Rela
- The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, and Bharath Institute of Higher Education and Research, Chennai, India
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
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7
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Udagawa D, Hasegawa Y, Obara H, Yamada Y, Shinoda M, Kitago M, Abe Y, Kuroda T, Kitagawa Y. Risk Assessment of Liver Transplantation After Kasai Portoenterostomy in Children and Adults. J Surg Res 2023; 290:109-115. [PMID: 37244216 DOI: 10.1016/j.jss.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/30/2023] [Accepted: 04/21/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Reports of liver transplantation (LT) after Kasai portoenterostomy (KPE) in adult patients with biliary atresia are scarce. The aim of this study was to evaluate the outcomes and investigate the risk factors of LT after KPE in both pediatric and adult patients. METHODS We retrospectively reviewed a prospective database of patients with biliary atresia who underwent LT after KPE. Eighty-nine consecutive patients were included, and risk factors for in-hospital mortality after LT were assessed. RESULTS The median age of the patients was 2 y (range, 0-45 y). Forty-six patients (51.7%) had a history of upper abdominal surgery after KPE. The in-hospital mortality rate was 5.6% (5 patients). Of these, 80% of patients with mortality were aged ≥17 y, and all patients with mortality had a history of two or more upper abdominal surgeries. In the univariate and receiver operating characteristic curve analyses, age ≥17 y and the number of previous upper abdominal surgeries ≥2 were identified as possible risk factors. CONCLUSIONS Our study suggests that older age and multiple previous upper abdominal surgeries are important risk factors for mortality after LT following KPE. We believe that these findings will serve as indications for safe LT in future patients.
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Affiliation(s)
- Daisuke Udagawa
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yasushi Hasegawa
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yohei Yamada
- Department of Pediatric Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masahiro Shinoda
- Digestive Diseases Center, International University of Health and Welfare, Mita Hospital, Minato-ku, Tokyo, Japan
| | - Minoru Kitago
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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8
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Kawaguchi Y, Terui K, Takenouchi A, Komatsu S, Saito T, Hishiki T. Outcomes of adult native liver survivors with biliary atresia: the current situation in Japan. Pediatr Surg Int 2023; 39:263. [PMID: 37668658 DOI: 10.1007/s00383-023-05551-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE This study aimed to elucidate the difficulties faced by adult native liver survivors with biliary atresia (BA) in Japan. METHODS A single-center, retrospective, observational study of 57 adult patients with BA was conducted. The clinical course of BA was compared between native liver survivors and non-survivors who reached adulthood. Indications and outcomes of liver transplantation (LT) among non-survivors were assessed. RESULTS A significantly larger portion of non-survivors (n = 10) met the criteria for LT (p < 0.001) and received treatment for portal hypertension after reaching 20 years of age (p < 0.01) compared with the survivors. Causes of death included liver cirrhosis (n = 8), graft failure of living donor liver transplantation (LDLT) (n = 1), and hepatocarcinoma (n = 1). Two of the non-survivors who died of liver cirrhosis had no indication for LT because of alcohol dependence and uncontrolled infection. An appropriate donor candidate could not be found for the five patients who opted for LDLT. All six patients waitlisted for deceased donor liver transplantation (DDLT) died after a median waiting period of 17 months. CONCLUSION Adult BA patients in Japan have limited options for LT, mainly owing to low donor candidate availability for LDLT and a low prevalence of DDLT.
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Affiliation(s)
- Yunosuke Kawaguchi
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Keita Terui
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
| | - Ayako Takenouchi
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Shugo Komatsu
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Takeshi Saito
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
- Department of Pediatric Surgery, Chiba Children's Hospital, 579-1 Heta-Cho, Midori-ku, Chiba, Japan
| | - Tomoro Hishiki
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
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Polat KY, Yazar Ş, Aslan S, Kargı A, Selimoğlu A, Gürbulak B, Astarcıoğlu İ. Comparing the Outcomes of Pediatric Liver Transplantation. Transplant Proc 2023:S0041-1345(23)00319-6. [PMID: 37302864 DOI: 10.1016/j.transproceed.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 05/12/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Liver transplantation is a life-saving treatment for end-stage pediatric liver failure. We aimed to present the results of pediatric liver transplants performed in our center in the last 11 years (between 2012 and March 2022) in association with prognostic factors affecting survival. METHODS Demographic characteristics, etiologic reasons, previous operations (Kasai procedure), morbidity, mortality, survival, and bilio-vascular complication rates were determined, and outcomes were evaluated. In the postoperative period, the duration of mechanical ventilation and intensive care unit stay and surgical and other complications were evaluated. Graft and patient survival rates were determined, and univariate and multivariate factors affecting these rates were evaluated. RESULTS In the last 10 years, 229 pediatric liver transplantaion (Pe-LT)/1513 adult liver taransplantation (Ad-LT) (21.35%) were performed in our center. This ratio (Pe-LT/Ad-LT ratio) is 1741/15,886 (10.95%) for our country. A total of 229 liver transplants were performed in 214 pediatric patients. Retransplantation was performed in 15 patients (6.55%). Cadaveric liver transplantation was performed in 9 patients. Graft survival rates were 87%, 83%, 78%, 78%, 78%, and 78% at <30 days, 30 to 90 days, 91 to 364 days, 1 to 3 years, and >3 years, respectively. Patient survival rates for <30 days, 30 to 90 days, 91 to 364 days, 1 to 3 years, and >3 years were 91.5%, 85.7%, 82%, 81.5%, and 81.5%, respectively. Our 5-year survival rates in metabolic diseases and the acute fulminant failure group are 93.8% and 100%, respectively. CONCLUSIONS The fact that the 1- and 5-year survival rates are the same shows that when patients overcome biliary vascular and infectious problems, their survival is prolonged.
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Affiliation(s)
- Kamil Yalçın Polat
- Organ Transplantation Center, Bahçelievler Memorial Hospital, Istanbul, Turkey
| | - Şerafettin Yazar
- Organ Transplantation Center, Bahçelievler Memorial Hospital, Istanbul, Turkey
| | - Serdar Aslan
- Organ Transplantation Center, Bahçelievler Memorial Hospital, Istanbul, Turkey
| | - Ahmet Kargı
- Organ Transplantation Center, Bahçelievler Memorial Hospital, Istanbul, Turkey
| | - Ayşe Selimoğlu
- Department of Pediatric Gastroenterology, Bahçelievler Memorial Hospital, Istanbul, Turkey
| | - Bünyamin Gürbulak
- Organ Transplantation Center, Bahçelievler Memorial Hospital, Istanbul, Turkey.
| | - İbrahim Astarcıoğlu
- Organ Transplantation Center, Bahçelievler Memorial Hospital, Istanbul, Turkey
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10
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Takase K, Ueno T, Matsuki K, Todo M, Iwasaki S, Deguchi K, Masahata K, Nomura M, Watanabe M, Kamiyama M, Tazuke Y, Kimura T, Okuyama H. Liver-Spleen Volume Ratio as a Predictor of Native Liver Survival in Patients with Biliary Atresia. Transplant Proc 2023:S0041-1345(23)00135-5. [PMID: 37087298 DOI: 10.1016/j.transproceed.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/13/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND The appropriate timing of liver transplantation (LT) in patients with biliary atresia (BA) who survived with their native livers until adolescence remains controversial. The liver-spleen volume ratio (LSR) has been reported to be efficacious in predicting the prognosis of chronic liver disease. We investigated whether LSR could predict long-term native liver prognosis and serve as an indication for LT in patients with BA. METHODS Patients with BA who survived with their native liver until the age of 15 years were included. These patients were classified into 2 groups. The unfavorable prognosis group included patients who underwent or were awaiting LT or developed complications such as refractory cholangitis or gastrointestinal bleeding due to esophagogastric or intestinal varices. The favorable prognosis group included patients who survived with their native liver without complications. We compared the 2 groups regarding LSR, hematological, and histologic data. RESULTS Of 19 patients, 8 were in the unfavorable prognosis group, and 11 were in the favorable prognosis group. LSR was significantly lower in the unfavorable prognosis group (P = .009). Analysis of the receiver operating characteristic curve showed that the area under the curve of the LSR was 0.891, which was higher than the area under the curve of liver fibrosis markers. The optimal LSR cut-off value for predicting poor native liver prognosis was 1.97, with a sensitivity of 75.0% and a specificity of 87.5%. CONCLUSIONS The LSR reflects splenomegaly and liver atrophy. The LSR might be a reliable predictor of native liver prognosis and could guide decisions about LT in patients with BA.
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Affiliation(s)
- Koki Takase
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takehisa Ueno
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Kyoko Matsuki
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Marie Todo
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shun Iwasaki
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Koihi Deguchi
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazunori Masahata
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Motonari Nomura
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Miho Watanabe
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masafumi Kamiyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yuko Tazuke
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takeshi Kimura
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Esmati H, van Rosmalen M, van Rheenen PF, de Boer MT, van den Berg AP, van der Doef HPJ, Rayar M, de Kleine RHJ, Porte RJ, de Meijer VE, Verkade HJ. Waitlist mortality of young patients with biliary atresia: Impact of allocation policy and living donor liver transplantation. Liver Transpl 2023; 29:157-163. [PMID: 37160064 PMCID: PMC9869936 DOI: 10.1002/lt.26529] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/18/2022] [Accepted: 05/26/2022] [Indexed: 01/29/2023]
Abstract
Patients with biliary atresia (BA) below 2 years of age in need of a transplantation largely rely on partial grafts from deceased donors (deceased donor liver transplantation [DDLT]) or living donors (living donor liver transplantation [LDLT]). Because of high waitlist mortality in especially young patients with BA, the Eurotransplant Liver Intestine Advisory Committee (ELIAC) has further prioritized patients with BA listed before their second birthday for allocation of a deceased donor liver since 2014. We evaluated whether this Eurotransplant (ET) allocation prioritization changed the waitlist mortality of young patients with BA. We used a pre-post cohort study design with the implementation of the new allocation rule between the two periods. Participants were patients with BA younger than 2 years who were listed for liver transplantation in the ET database between 2001 and 2018. Competing risk analyses were performed to assess waitlist mortality in the first 2 years after listing. We analyzed a total of 1055 patients with BA, of which 882 had been listed in the preimplementation phase (PRE) and 173 in the postimplementation phase (POST). Waitlist mortality decreased from 6.7% in PRE to 2.3% in POST ( p = 0.03). Interestingly, the proportion of young patients with BA undergoing DDLT decreased from 32% to 18% after ET allocation prioritization ( p = 0.001), whereas LDLT increased from 55% to 74% ( p = 0.001). The proportional increase in LDLT decreased the median waitlist duration of transplanted patients from 1.5 months in PRE to 0.85 months in POST ( p = 0.003). Since 2014, waitlist mortality in young patients with BA has strongly decreased in the ET region. Rather than associated with prioritized allocation of deceased donor organs, the decreased waitlist mortality was related to a higher proportion of patients undergoing LDLT.
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Affiliation(s)
- Hedayatullah Esmati
- Department of Pediatric Gastroenterology and Hepatology , University Medical Center Groningen, University of Groningen , Groningen , the Netherlands
| | | | - Patrick F van Rheenen
- Department of Pediatric Gastroenterology and Hepatology , University Medical Center Groningen, University of Groningen , Groningen , the Netherlands
| | - Marieke T de Boer
- Department of Surgery, University Medical Center Groningen , University of Groningen , Groningen , the Netherlands
| | - Aad P van den Berg
- Department of Gastroenterology and Hepatology, University Medical Center Groningen , University of Groningen , Groningen , the Netherlands
| | - Hubert P J van der Doef
- Department of Pediatric Gastroenterology and Hepatology , University Medical Center Groningen, University of Groningen , Groningen , the Netherlands
| | - Michel Rayar
- Department of Surgery, University Medical Center Groningen , University of Groningen , Groningen , the Netherlands
| | - Ruben H J de Kleine
- Department of Surgery, University Medical Center Groningen , University of Groningen , Groningen , the Netherlands
| | - Robert J Porte
- Department of Surgery, University Medical Center Groningen , University of Groningen , Groningen , the Netherlands
| | - Vincent E de Meijer
- Department of Surgery, University Medical Center Groningen , University of Groningen , Groningen , the Netherlands
| | - Henkjan J Verkade
- Department of Pediatric Gastroenterology and Hepatology , University Medical Center Groningen, University of Groningen , Groningen , the Netherlands
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12
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Khan SA, Ali N, Dar FS, Malik MI. Biliary atresia-An experience from the first pediatric liver transplant center in Pakistan. Pediatr Transplant 2023; 27:e14357. [PMID: 35831918 DOI: 10.1111/petr.14357] [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] [Received: 01/08/2022] [Revised: 05/09/2022] [Accepted: 06/28/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Biliary atresia (BA) is the most common cause of neonatal cholestatic syndrome. The true incidence of BA in Pakistan is largely unknown. AIM This study aimed to report the clinical features, age at diagnosis and outcomes of biliary atresia from the first pediatric liver transplant center in Pakistan. METHODS The study was done in Shifa International hospital from 2013 to 2020. All babies who had biliary atresia confirmed by laboratory investigation were included. Demographic data, age of presentation, clinical presentation, supporting investigations like liver function tests, ultrasound abdomen, HIDA scan and liver biopsy were noted. Outcome related to Kasai portoenterostomy, liver transplant, complications and immunosuppressant agents were noted. RESULT A total of 42 children were included, 23 (54.7%) males and 19 (45.2%) were females. Jaundice was seen in all patients (100%) followed by acholic stools (81%). Associated malformations were noted in 6 (14.2%) patients. Liver function tests confirmed obstructive cholestasis (p 0.04). Kasai was done in 19 (45%) patients only, living donor liver transplant was performed in 6 (14%) patients. Age range of transplant patients was from 3 months to 1 year. Indication for liver transplant was failed Kasai in 1(16.7%) patient and chronic liver disease in 5 (83.3%) patients. LDLT survivors were 10 months to 1 year of age at the time of transplant, mean age was 10.6 months. Maximum survival noted so far is 7 years. Acute complications seen post-transplant were sepsis (three patients), surgical site infections (two patients), biliary leaks and acute cellular rejection in one patient each. Chronic graft rejection, portal vein stricture needing stenting was done in one patient. DISCUSSION All patients underwent LDLT from related donors wih no donor related mortality. All are deceased patients were yonger and had advanced disease. BA remains third most commo indication of transplant in our center. CONCLUSION Liver transplant is the only lifesaving procedure after failed Kasai or as primary liver transplant due to advance liver disease. The advent of liver transplantation services offers survival and improving outlook of the disease.
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Affiliation(s)
- Sabeen Abid Khan
- Pediatrics, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Naurin Ali
- Pediatrics, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Faisal Saud Dar
- Hepatobiliary Surgeon in Shifa International Hospital, Pakistan Kidney Liver Institute (PKLI), Lahore, Pakistan
| | - Munir Iqbal Malik
- Pediatric Gastroenterology, Shifa International Hospital, Shifa College of Medicine, Islamabad, Pakistan
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13
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Ren J, Dong C, Sun C, Wang K, Zhang W, Zheng W, Qin H, Han C, Yang Y, Zhang F, Wei X, Gao W, Zheng H. The impact of portal vein reconstruction on portal vein complications after pediatric living-donor liver transplantation with left lobe graft. Surgery 2023; 173:537-543. [PMID: 36424198 DOI: 10.1016/j.surg.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/10/2022] [Accepted: 10/14/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study aimed to determine whether the different methods of portal vein reconstruction have an impact on the occurrence of portal vein complications after pediatric living-donor liver transplantation with left lobe graft. METHODS A total of 567 recipients were eligible for enrollment in this study and were divided into the following 2 groups according to the type of portal vein reconstruction: group 1 underwent anastomosis of the left and right bifurcations of the recipient portal vein to the donor portal vein (type 1), whereas group 2 underwent anastomosis of the bevel formed by the main trunk and right branch of the recipient portal vein to the donor portal vein (type 2). Postoperative portal vein complications and recipient and graft survival rates were compared between the 2 groups before and after propensity score matching. RESULTS Portal vein complications occurred in 53 (9.3%) patients, including 46 recipients with portal vein stenosis and 7 with portal vein thrombosis. After propensity score matching, the incidence of portal vein stenosis in group 2 was lower than that in group 1 (P = .035). The first diagnosis time of portal vein stenosis in group 2 was later than that in group 1 (P = .033), and the incidence of early portal vein stenosis was lower than that in group 1 (P = .009). There were no statistically significant differences in the incidence of portal vein thrombosis and recipient and graft survival rates between the 2 groups. CONCLUSIONS Type 2 portal vein reconstruction appears to be a viable technique in pediatric living-donor liver transplantation with left lobe graft that can effectively reduce the incidence of portal vein stenosis.
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Affiliation(s)
- Jiashu Ren
- The First Central Clinical School, Tianjin Medical University, China
| | - Chong Dong
- Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, China; Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China
| | - Chao Sun
- Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, China; Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China
| | - Kai Wang
- Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, China; Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China
| | - Wei Zhang
- Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, China; Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China
| | - Weiping Zheng
- Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, China; Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China
| | - Hong Qin
- Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, China; Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China
| | - Chao Han
- Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, China; Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China
| | - Yang Yang
- Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, China; Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China
| | - Fubo Zhang
- Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, China; Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China
| | - Xinzhe Wei
- Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, China; Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China
| | - Wei Gao
- Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, China; Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China.
| | - Hong Zheng
- Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China; Organ Transplantation Center, Tianjin First Central Hospital, China; Key Laboratory of Transplant Medicine, Chinese Academy of Medical Sciences, Tianjin First Central Hospital, China; Research Institute of Transplant Medicine, Nankai University, China.
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14
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Treatments and outcomes of intra-operative portal vein thrombosis in living-donor liver transplantation due to biliary atresia. J Pediatr Surg 2022; 57:947-954. [PMID: 35810021 DOI: 10.1016/j.jpedsurg.2022.06.010] [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] [Received: 12/24/2021] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pediatric living-donor liver transplantation (LDLT) has become one of the most effective therapies for pediatric end-stage liver diseases. We aim to investigate the risk factors for intra-operative portal vein thrombosis (PVT) and the short- and long-term outcomes in children post LDLT. METHODS This was a retrospective analysis from 584 cases of biliary atresia (BA) patients who had undergone LDLT from January 2014 to December 2019 at our hospital. Patients were divided into PVT and non-PVT groups according to the occurrence of PVT during LDLT. RESULTS The median age of recipients at transplantation was 7.22 (quartiles, 6.03, 9.50) months, the incidence of intra-operative PVT was 5.31% (31/584). The independent risk factors for intra-operative PVT were the diameter of the recipient's PV not greater than 4 mm and a higher ratio of graft-to-recipient PV diameter. The cumulative survival rates of grafts and recipients were 93.5% and 93.5% in the PVT group, and 94.9% and 95.3% in the non-PVT group, respectively, without significant difference. The recovery of graft function was similar in recipients with or without interposed graft vessel (IGV). However, the incidence of PV stenosis was higher in recipients with IGV after LDLT. CONCLUSION Intra-operative PVT is a common complication in pediatric LDLT, but an excellent prognosis can be achieved by appropriate and individualized surgical treatment. We noted that intra-operative PVT did not affect the survival rates of grafts and recipients, but there was a higher incidence of PV complications after LDLT. LEVEL OF EVIDENCE Ⅲ.
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15
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Valentino PL. "Long-term" is getting longer for children receiving liver transplantation grafts. Liver Transpl 2022; 28:1827-1828. [PMID: 35912450 DOI: 10.1002/lt.26550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Pamela L Valentino
- Gastroenterology & Hepatology Division, Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
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16
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Okamoto T, Okajima H, Ogawa E, Sonoda M, Uebayashi EY, Ito T, Seo S, Hata K, Masui T, Taura K, Uemoto S, Hatano E. Progress in living donor liver transplantation for biliary atresia and challenges faced: A thirty-year single institutional experience. J Pediatr Surg 2022; 57:649-655. [PMID: 35393118 DOI: 10.1016/j.jpedsurg.2022.03.009] [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] [Received: 12/01/2021] [Revised: 02/28/2022] [Accepted: 03/09/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Biliary atresia (BA) is the most common indication for liver transplantation in the pediatric population, and living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT) have been established as a radical treatment for BA .The aim of this study was to clarify the long term outcomes and risk factors affecting the LDLT outcomes, as well as the challenges faced. METHODS Between 1990 and 2019, 666 BA patients underwent LDLT in our institution and were enrolled in this study. Data regarding the recipient's age, anatomic findings of the biliary tree at Kasai's portoenterostomy, basic characteristics at transplantation, transplant profiles, donor characteristics, and outcomes of LDLT were analyzed. RESULTS The 1-, 5-, 10-, 15-, 20-, and 25-year graft survival rates of BA patients who underwent LDLT were 88.1%, 85.4%, 81.5%, 78.9%, 76.6%, and 75.5%, respectively. The transplant era, age at transplantation, ABO incompatible transplant, and presence of pulmonary vascular complications were identified as significant risk factors for overall graft survival. When the study period was divided into the first (1990-1999) and second (2000-2019) phases and re analyzed, the outcomes of ABO-incompatible transplants and LDLT for adult BA patients remained inferior to others in the second phase. The 20-year graft survival rate in patients who underwent re transplantation in the second phase was 54.2%. CONCLUSIONS The outcomes of LDLT in children are generally good, but the immunosuppression procedures need to be further improved for ABO-incompatible cases in the future. Further improvements in LDLT results for adult patients and re transplantation remain challenges to be addressed in this field, and future attempts, including revision to the organ allocation system of deceased donors, are necessary. LEVEL OF EVIDENCE Level III (case control study).
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Affiliation(s)
- Tatsuya Okamoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan.
| | - Hideaki Okajima
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan; Department of Pediatric Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Eri Ogawa
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Mari Sonoda
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Elena Yukie Uebayashi
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Takashi Ito
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Satoru Seo
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Koichiro Hata
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Toshihiko Masui
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Kojiro Taura
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | | | - Etsurou Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
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17
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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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18
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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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19
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Okamoto T, Okajima H, Uebayashi EY, Ogawa E, Yamada Y, Umeda K, Hiramatsu H, Hatano E. Management of Epstein-Barr Virus Infection and Post-Transplant Lymphoproliferative Disorder in Pediatric Liver Transplantation. J Clin Med 2022; 11:jcm11082166. [PMID: 35456259 PMCID: PMC9031649 DOI: 10.3390/jcm11082166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 11/27/2022] Open
Abstract
With the advancement of immunosuppressive strategies, the outcome of liver transplantation during childhood has dramatically improved. On the other hand, Epstein–Barr virus (EBV) infection and associated post-transplant lymphoproliferative diseases (PTLD), such as malignant lymphoma, are serious complications that contribute to morbidity and mortality, and are still an important issue today. Recently, an early diagnosis by quantitative PCR and PET-CT testing, and treatment with rituximab (an anti-CD20 antibody) has been established, and long-term remission has been achieved in many cases. However, the optimal immunosuppression protocol after remission of PTLD needs to be determined, and it is hoped that a treatment for refractory PTLD (e.g., PTL-NOS) will be proposed.
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Affiliation(s)
- Tatsuya Okamoto
- Department of Pediatric Surgery, Kyoto University Hospital, Kyoto 606-8507, Japan; (H.O.); (E.Y.U.); (E.O.); (E.H.)
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
- Correspondence:
| | - Hideaki Okajima
- Department of Pediatric Surgery, Kyoto University Hospital, Kyoto 606-8507, Japan; (H.O.); (E.Y.U.); (E.O.); (E.H.)
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
- Department of Pediatric Surgery, Kanazawa Medical University Hospital, Kanazawa 920-0265, Japan
| | - Elena Yukie Uebayashi
- Department of Pediatric Surgery, Kyoto University Hospital, Kyoto 606-8507, Japan; (H.O.); (E.Y.U.); (E.O.); (E.H.)
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Eri Ogawa
- Department of Pediatric Surgery, Kyoto University Hospital, Kyoto 606-8507, Japan; (H.O.); (E.Y.U.); (E.O.); (E.H.)
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Yosuke Yamada
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto 606-8507, Japan;
| | - Katsutsugu Umeda
- Department of Pediatrics, Kyoto University Hospital, Kyoto 606-8507, Japan; (K.U.); (H.H.)
| | - Hidefumi Hiramatsu
- Department of Pediatrics, Kyoto University Hospital, Kyoto 606-8507, Japan; (K.U.); (H.H.)
| | - Etsurou Hatano
- Department of Pediatric Surgery, Kyoto University Hospital, Kyoto 606-8507, Japan; (H.O.); (E.Y.U.); (E.O.); (E.H.)
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
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20
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Variability of Care and Access to Transplantation for Children with Biliary Atresia Who Need a Liver Replacement. J Clin Med 2022; 11:jcm11082142. [PMID: 35456234 PMCID: PMC9032543 DOI: 10.3390/jcm11082142] [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: 01/29/2022] [Revised: 02/24/2022] [Accepted: 03/09/2022] [Indexed: 02/04/2023] Open
Abstract
Background & Aims: Biliary atresia (BA) is the commonest single etiology indication for liver replacement in children. As timely access to liver transplantation (LT) remains challenging for small BA children (with prolonged waiting time being associated with clinical deterioration leading to both preventable pre- and post-transplant morbidity and mortality), the care pathway of BA children in need of LT was analyzed—from diagnosis to LT—with particular attention to referral patterns, timing of referral, waiting list dynamics and need for medical assistance before LT. Methods: International multicentric retrospective study. Intent-to-transplant study analyzing BA children who had indication for LT early in life (aged < 3 years at the time of assessment), over the last 5 years (2016−2020). Clinical and laboratory data of 219 BA children were collected from 8 transplant centers (6 in Europe and 2 in USA). Results: 39 patients underwent primary transplants. Children who underwent Kasai in a specialist -but not transplant- center were older at time of referral and at transplant. At assessment for LT, the vast majority of children already were experiencing complication of cirrhosis, and the majority of children needed medical assistance (nutritional support, hospitalization, transfusion of albumin or blood) while waiting for transplantation. Severe worsening of the clinical condition led to the need for requesting a priority status (i.e., Peld Score exception or similar) for timely graft allocation for 76 children, overall (35%). Conclusions: As LT currently results in BA patient survival exceeding 95% in many expert LT centers, the paradigm for BA management optimization and survival have currently shifted to the pre-LT management. The creation of networks dedicated to the timely referral to a pediatric transplant center and possibly centralization of care should be considered, in combination with implementing all different graft type surgeries in specialist centers (including split and living donor LTs) to achieve timely LT in this vulnerable population.
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21
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Direct health care cost of treatment and medication of biliary atresia patients using the National Database of Health Insurance Claims and Specific Health Checkups. Pediatr Surg Int 2022; 38:547-554. [PMID: 35165784 PMCID: PMC8913443 DOI: 10.1007/s00383-022-05079-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Treatment of biliary atresia (BA), which typically requires an initial surgical intervention called the Kasai procedure (KP) and possible liver transplant (LT) afterwards, is quite resource-intensive and would affect patients and families for a lifetime; yet a comprehensive view of the economic burden has not been reported. We estimated direct health care costs from the public payer perspective using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. METHODS Children newly diagnosed at ages 0 days to 4 years between April 2010 and September 2019 were identified. Costs of treatment were estimated for six phases of care: prediagnosis, KP and inpatient hospitalization, follow-up after KP, pre-transplant checkup, LT and inpatient hospitalization, and follow-up after LT. RESULTS Mean total prediagnosis medical cost was $6847 (USD) and KP and inpatient hospitalization was $42,157 per year. Follow-up after KP was $15,499, and pre-transplant checkup after KP was $36,015 per year. Mean cost for LT and inpatient hospitalization was $105,334, and follow-up after liver transplant was $25,459 per year. CONCLUSIONS Treatment of BA requires extensive medical resource consumption. The use of the comprehensive national database allowed us to estimate the costs which will be useful for health service planning and cost-effectiveness analysis.
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22
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de Ville de Goyet J, Baumann U, Karam V, Adam R, Nadalin S, Heaton N, Reding R, Branchereau S, Mirza D, Klempnauer JL, Fischer L, Kalicinski P, Colledan M, Lopez Santamaria M, de Kleine RH, Chardot C, Yilmaz S, Kilic M, Boillot O, di Francesco F, Polak WG, Verkade HJ. European Liver Transplant Registry: Donor and transplant surgery aspects of 16,641 liver transplantations in children. Hepatology 2022; 75:634-645. [PMID: 34724224 DOI: 10.1002/hep.32223] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 09/12/2021] [Accepted: 10/16/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS The European Liver Transplant Registry (ELTR) has collected data on liver transplant procedures performed in Europe since 1968. APPROACH AND RESULTS Over a 50-year period (1968-2017), clinical and laboratory data were collected from 133 transplant centers and analyzed retrospectively (16,641 liver transplants in 14,515 children). Data were analyzed according to three successive periods (A, before 2000; B, 2000-2009; and C, since 2010), studying donor and graft characteristics and graft outcome. The use of living donors steadily increased from A to C (A, n = 296 [7%]; B, n = 1131 [23%]; and C, n = 1985 [39%]; p = 0.0001). Overall, the 5-year graft survival rate has improved from 65% in group A to 75% in group B (p < 0.0001) and to 79% in group C (B versus C, p < 0.0001). Graft half-life was 31 years, overall; it was 41 years for children who survived the first year after transplant. The late annual graft loss rate in teenagers is higher than that in children aged <12 years and similar to that of young adults. No evidence for accelerated graft loss after age 18 years was found. CONCLUSIONS Pediatric liver transplantation has reached a high efficacy as a cure or treatment for severe liver disease in infants and children. Grafts that survived the first year had a half-life similar to standard human half-life. Transplantation before or after puberty may be the pivot-point for lower long-term outcome in children. Further studies are necessary to revisit some old concepts regarding transplant benefit (survival time) for small children, the role of recipient pathophysiology versus graft aging, and risk at transition to adult age.
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Affiliation(s)
- Jean de Ville de Goyet
- Department for the Treatment and Study of Pediatric Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico, Palermo, Italy
| | - Ulrich Baumann
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.,Paediatric Gastroenterology and Hepatology, Hannover Medical School, Hannover, Germany.,European Liver and Intestine Transplant Association, Padua, Italy
| | - Vincent Karam
- European Liver Transplant Registry, Assistance Publique-Hôpitaux de Paris Hôpital Paul Brousse, Université Paris-Sud, Inserm U 935, Villejuif, France
| | - René Adam
- European Liver and Intestine Transplant Association, Padua, Italy.,European Liver Transplant Registry, Assistance Publique-Hôpitaux de Paris Hôpital Paul Brousse, Université Paris-Sud, Inserm U 935, Villejuif, France
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | | | - Raymond Reding
- Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - Sophie Branchereau
- Service de Chirurgie Viscérale Pédiatrique Bicêtre University Hospital, Faculty of Medicine Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - Darius Mirza
- Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jürgen L Klempnauer
- Klinik für Viszeral und Transplantations-chirurgie, Hannover Medical School, Hannover, Germany
| | - Lutz Fischer
- Department of Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Piotr Kalicinski
- Department of Pediatric and Transplant Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Michele Colledan
- Università degli studi di Milano Bicocca, ASST Giovanni XXIII, Department of Organ Failure and Transplantation, Bergamo, Italy
| | | | - Ruben H de Kleine
- Department of Surgery, Section of Hepato-Pancreatico-Biliary Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Christophe Chardot
- Service de Chirurgie Pediatrique, Hôpital Necker Enfants Malades, Paris, France
| | - Sezai Yilmaz
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Murat Kilic
- Liver Transplant Program, Izmir Kent Hospital, Izmir, Turkey
| | - Olivier Boillot
- Pediatric Liver Transplant Surgery, Hôpital Edouard Herriot, Lyon, France
| | - Fabrizio di Francesco
- Department for the Treatment and Study of Pediatric Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico, Palermo, Italy
| | - Wojciech G Polak
- European Liver and Intestine Transplant Association, Padua, Italy.,Erasmus MC, Transplant Institute, Division of Hepatopancreatobiliary and Transplant Surgery, Department of Surgery, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Henkjan J Verkade
- European Liver and Intestine Transplant Association, Padua, Italy.,Department of Pediatrics, University Medical Center Groningen, University of Groningen, Hospital, Groningen, the Netherlands
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- European Liver Transplant Registry, Assistance Publique-Hôpitaux de Paris Hôpital Paul Brousse, Université Paris-Sud, Inserm U 935, Villejuif, France
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23
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Kawabata S, Sakamoto R, Uto K, Irie T, Kadohisa M, Shimata K, Narita Y, Isono K, Honda M, Hayashida S, Ohya Y, Yamamoto H, Yamamoto H, Nakano M, Sugawara Y, Inomata Y, Hibi T. Intellectual development of patients with biliary atresia who underwent living donor liver transplantation in infancy. Pediatr Surg Int 2022; 38:201-208. [PMID: 34779867 DOI: 10.1007/s00383-021-05042-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The impact of pediatric liver transplantation on intellectual development has yet to be determined. We investigated the intellectual outcomes of school-aged patients after living donor liver transplantation for biliary atresia in infancy. METHODS The Wechsler Intelligence Scale for Children-fourth edition test was administered to 20 patients who survived [Formula: see text] 5 years after living donor liver transplantation. Borderline full scale intelligence quotient was defined as ≤ 85. Pre-, peri-, and postoperative data were compared between patients with > 85 and ≤ 85 to identify predictive factors of borderline performance. RESULTS The one-sample t test demonstrated that the mean full scale intelligence quotient of patients after transplantation for biliary atresia was significantly lower than that of the general population (91.8 vs. 100.0, p = 0.026) and 7 (35%) were classified as intellectual borderline functioning. Multivariable logistic regression models were unable to identify any factors predictive of full scale intelligence quotients of ≤ 85. CONCLUSION This is the first study to indicate that the mean full scale intelligence quotient among school-aged patients who underwent living donor liver transplantation for biliary atresia in infancy is significantly lower than that of the general population.
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Affiliation(s)
- Seiichi Kawabata
- Department of Pediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Rieko Sakamoto
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Keiichi Uto
- Department of Pediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Tomoaki Irie
- Department of Pediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masashi Kadohisa
- Department of Pediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Keita Shimata
- Department of Pediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yasuko Narita
- Department of Pediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Kaori Isono
- Department of Pediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masaki Honda
- Department of Pediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Shintaro Hayashida
- Department of Pediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yuki Ohya
- Department of Pediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hidekazu Yamamoto
- Department of Pediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hirotoshi Yamamoto
- Department of Pediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Miwako Nakano
- Department of Pediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yasuhiko Sugawara
- Department of Pediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yukihiro Inomata
- Department of Pediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
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24
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Sanada Y, Sakuma Y, Onishi Y, Okada N, Hirata Y, Horiuchi T, Omameuda T, Lefor AK, Sata N. Long-term outcomes in pediatric patients who underwent living donor liver transplantation for biliary atresia. Surgery 2022; 171:1671-1676. [PMID: 35027207 DOI: 10.1016/j.surg.2021.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/20/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is no consensus about long-term outcomes in patients with biliary atresia. We retrospectively reviewed the long-term outcomes in pediatric patients who underwent living donor liver transplantation for biliary atresia. METHODS Between May 2001 and December 2020, 221 (73%) of 302 pediatric patients who underwent living donor liver transplantation had biliary atresia. The median age at living donor liver transplantation was 1.2 (range 0.2-16.5) years, and follow-up was 10.3 ± 5.5 years. RESULTS The 10-year graft survival rates in patients with and without biliary atresia were 94% and 89%, respectively (P = .019). The 10-year graft survival was significantly poorer in patients ≥12 years of age (84%) versus those <12 years of age at living donor liver transplantation (0-2 years: 95%; 2-12 years: 96%) (P = .016). The causes of graft failure in patients with biliary atresia included late-onset refractory rejection (n = 6), bowel perforation (n = 2), and acute encephalitis (n = 2), as well as cerebral hemorrhage, hepatic vein thrombosis, and sepsis (n = 1 for all). All 7 patients with graft failure due to refractory rejection and hepatic vein thrombosis underwent repeated liver transplantation and are alive in 2021. The rates of post-transplant portal vein complications and early-onset acute cellular rejection in patients with biliary atresia were higher than in those without biliary atresia (P = .042 and P = .022, respectively). In 2021, of 60 adolescents with biliary atresia, 14 (23%) reported medication nonadherence. The rate of liver dysfunction due to late-onset acute cellular rejection and graft failure due to late-onset refractory rejection in patients with nonadherence was higher than in patients with satisfactory adherence (P = .009). CONCLUSION The long-term prognosis after living donor liver transplantation in pediatric patients with biliary atresia is quite good. However, long-term support to enhance medication adherence is required in adolescents with biliary atresia.
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Affiliation(s)
- Yukihiro Sanada
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi, Japan.
| | - Yasunaru Sakuma
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi, Japan
| | - Yasuharu Onishi
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi, Japan
| | - Noriki Okada
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi, Japan
| | - Yuta Hirata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi, Japan
| | - Toshio Horiuchi
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi, Japan
| | - Takahiko Omameuda
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi, Japan
| | - Naohiro Sata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi, Japan
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25
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Kobayashi T, Kinoshita Y, Takahashi Y, Ohyama T, Arai Y, Yokota N, Saito K, Miura K, Ishikawa H, Sakata J, Wakai T. Usefulness of Living Donor Liver Transplantation for Patients After Undergoing the Kasai Operation for Biliary Atresia. Transplant Proc 2022; 54:435-437. [DOI: 10.1016/j.transproceed.2021.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
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26
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Takeda M, Sakamoto S, Uchida H, Shimizu S, Yanagi Y, Fukuda A, Uchida H, Yamataka A, Kasahara M. Comparative study of open and laparoscopic Kasai portoenterostomy in children undergoing living donor liver transplantation for biliary atresia. Pediatr Surg Int 2021; 37:1683-1691. [PMID: 34453589 DOI: 10.1007/s00383-021-04994-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The effectiveness of laparoscopic Kasai portoenterostomy (Laparoscopic-KPE) for biliary atresia (BA) has been reported but remains controversial. We reviewed our own cases and cases described in previous studies of liver transplantation (LT) for BA after Laparoscopic-KPE to investigate the efficacy of Laparoscopic-KPE. METHODS Subjects were children of ≤ 2 years old with LT for BA after KPE who underwent Laparoscopic-KPE (n = 10) or Open-KPE (n = 115) between 2009 and 2020. Propensity score matching was performed to reduce the effect of treatment selection bias. The clinical data regarding the preoperative characteristics and surgical results were compared. RESULTS The rates of hypoplastic portal vein and retrograde portal vein flow were lower in the Laparoscopic-KPE group than in the Open-KPE group (0 vs. 40.0%, p = 0.02 and 0 vs. 35.0%, p = 0.04). There was no marked difference in the operation time or duration of hepatectomy. For portal vein reconstruction, a vein graft was not required in the Laparoscopic-KPE group (0 vs. 35.0%, p = 0.03). No patients in the Laparoscopic-KPE group developed portal vein complications or required re-laparotomy for bowel perforation or re-bleeding, in contrast to the Open-KPE group (0 vs. 15.0% and 0 vs. 10.0%, respectively). CONCLUSION Laparoscopic-KPE may reduce postoperative complications that necessitate re-laparotomy in LT.
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Affiliation(s)
- Masahiro Takeda
- Organ Transplantation Center, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Seisuke Sakamoto
- Organ Transplantation Center, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Hajime Uchida
- Organ Transplantation Center, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Seiichi Shimizu
- Organ Transplantation Center, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Yusuke Yanagi
- Organ Transplantation Center, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Akinari Fukuda
- Organ Transplantation Center, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Mureo Kasahara
- Organ Transplantation Center, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
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27
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Hiratsuka K, Nakamura N, Sato N, Saito T. How Parents of Adolescents and Young Adults with Biliary Atresia Surviving with Native Livers Transfer the Responsibility of Medical Treatment to Their Children in Japan. J Pediatr Nurs 2021; 61:115-121. [PMID: 34023555 DOI: 10.1016/j.pedn.2021.05.004] [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] [Received: 10/03/2020] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study examines how the parents of adolescents and young adults with biliary atresia, surviving with their native livers, transfer medical treatment responsibility to their children, and how becoming a living liver transplant donor affects this process. The basis for the study was that becoming a living liver transplant donor may influence the transfer of responsibility. METHODS A qualitative, descriptive design was employed using a modified grounded theory approach. Data were collected from eight parents from November 2016 to August 2017 through semi-structured interviews conducted in two Japanese hospitals. Interpretive analysis from the viewpoint of the analytical theme and analytical focus person was conducted, resulting in a diagram and storyline explaining the process. FINDINGS Five categories were generated from one father and seven mothers (aged 40-60 years) of outpatients (aged 17-25 years): parental ability to cherish the child's "now" (live in the moment); put the brakes on their child's life; learn as they go; leave the child's life to the child; and openly express reservations about becoming a living liver transplant donor for their child. DISCUSSION Parental transfer of responsibility for treatment may be influenced by close-knit parent-child relationships, perception of the child's growth, and parental concern about becoming a living donor. APPLICATION TO PRACTICE Care providers should understand parent-child relationships and the parents' concerns about becoming living donors, thereby enabling them to recognize that medical treatment control must be relinquished to foster children's autonomy as adults.
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Affiliation(s)
| | | | - Naho Sato
- Graduate School of Nursing, Chiba University, Japan
| | - Takeshi Saito
- Division of pediatric surgery, Chiba Children's Hospital, Japan
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28
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Li J, Ma M, Wang X, Jiang W. Prevention and treatment of new hepatitis B after living donor liver transplantation in children. Transl Pediatr 2021; 10:1610-1617. [PMID: 34295775 PMCID: PMC8261585 DOI: 10.21037/tp-20-485] [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: 12/31/2020] [Accepted: 04/29/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND This study aimed to explore the prevention and treatment of new hepatitis B in children after liver transplantation with livers positive for HBcAg and to examine the treatment of new hepatitis B. METHODS A total of 22 children who received livers positive for HBcAg between January 2013 and December 2015 were retrospectively analyzed. After their operations, the children were given lamivudine for anti-hepatitis B virus (HBV) treatment, a hepatitis B vaccine or intermittent supplements of hepatitis B immunoglobulins to prevent recurrence of the infection, and entecavir for anti-hepatitis B treatment. The children were categorized into two groups: one group of children stopped taking lamivudine one year after operation (n=7) by themselves, while the other group did not (n=15). RESULTS Of the seven children who stopped lamivudine anti-HBV treatment, six developed hepatitis B at 24.33±13.95 months after operation. Of these children, five were treated with entecavir, resulting in their HBV DNA decreasing to undetectable levels (<50 IU/mL). HBsAg turned negative in four of these patients, but in one patient it did not. The other patient with new hepatitis B continued to use lamivudine, resulting in their HBV DNA decreasing to normal levels (<50 IU/mL) but without their HBsAg turning negative. No new cases of hepatitis B were found in the 15 children who did not stop anti-HBV treatment. CONCLUSIONS The long-term prophylactic therapy of nucleoside analogues combined with hepatitis B immunoglobulins should be used for a long time after liver transplantation with a liver positive for HBcAg. Discontinuation of nucleoside analogues is associated with a higher risk of the new onset of hepatitis B. Entecavir has a significant effect on the treatment of postoperative new hepatitis B in children.
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Affiliation(s)
- Junjie Li
- Department of Liver Transplantation, Tianjin First Center Hospital, Tianjin, China
| | - Ming Ma
- Department of Liver Transplantation, Tianjin First Center Hospital, Tianjin, China
| | - Xiaodong Wang
- Department of Liver Transplantation, Tianjin First Center Hospital, Tianjin, China
| | - Wentao Jiang
- Department of Liver Transplantation, Tianjin First Center Hospital, Tianjin, China
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29
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Honda M, Shimata K, Sambommatsu Y, Ibuki S, Isono K, Yamamoto H, Sugawara Y, Sakamoto S, Inomata Y, Hibi T. Hungry Bone Syndrome After Living Donor Liver Transplant for Biliary Atresia. EXP CLIN TRANSPLANT 2021; 19:386-389. [PMID: 33834957 DOI: 10.6002/ect.2020.0413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hungry bone syndrome is a rare but potentially lethal complication that is characterized by rapid, severe, long-lasting hypocalcemia and hypophosphatemia secondary to increased bone metabolism. We present a case of hungry bone syndrome after living donor liver transplant for biliary atresia. Following a failed Kasai procedure for biliary atresia, a 5-month-old boy underwent living donor liver transplant with reduced left lateral lobe from his father. Despite the oral administration of alfacalcidol, the patient exhibited severe craniotabes before the surgery. He developed severe hypocalcemia and hypophosphatemia im-mediately after liver transplant and required supplementation of calcium and phosphorus for 1 month thereafter. After serum levels of calcium and phosphate had normalized, there was a rapid increase in the serum bone-type alkaline phosphatase level, and the craniotabes subsided remarkably. To our knowledge, this is the world's first reported case of hungry bone syndrome after liver transplant for cholestatic cirrhosis. It underscores the importance of strict nutritional and electrolyte management in the perioperative period. A prompt diagnosis and correction of hungry bone syndrome are imperative to prevent the associated significant morbidity and mortality.
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Affiliation(s)
- Masaki Honda
- From the Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
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30
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Grimaldi C, Spada M, Maggiore G. Liver Transplantation in Children: An Overview of Organ Allocation and Surgical Management. Curr Pediatr Rev 2021; 17:245-252. [PMID: 34086551 DOI: 10.2174/1573396317666210604111538] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 11/22/2022]
Abstract
Liver transplantation is the standard treatment for children with end-stage liver disease, primary hepatic neoplasms, or liver-localized metabolic defects. Perioperative mortality is almost absent, and long-term survival exceeds 90%. Organ shortage is managed thanks to advances in organ retrieval techniques; living donation and partial liver transplantation almost eliminated waiting list mortality, thus leading to expanding indications for transplantation. The success of pediatric liver transplantation depends on the prompt and early referral of patients to transplant Centers and on the close and integrated multidisciplinary collaboration between pediatricians, hepatologists, surgeons, intensivists, oncologists, pathologists, coordinating nurses, psychologists, and social workers.
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Affiliation(s)
- Chiara Grimaldi
- Hepatobiliopancreatic and Abdominal Transplant Surgery, IRCCS Bambino Gesù Pediatric Hospital, Rome,Italy
| | - Marco Spada
- Hepatobiliopancreatic and Abdominal Transplant Surgery, IRCCS Bambino Gesù Pediatric Hospital, Rome,Italy
| | - Giuseppe Maggiore
- Hepatogastroenterology and Nutrition, IRCCS Bambino Gesù Pediatric Hospital, Rome,Italy
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31
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Sun C, Song Z, Ma N, Meng X, Dong C, Wang K, Qin H, Yang Y, Han C, Zhang F, Gao W. The management and outcomes of ABO-incompatible pediatric liver transplantation: Experience of a single Chinese center. J Pediatr Surg 2020; 55:2647-2652. [PMID: 32171534 DOI: 10.1016/j.jpedsurg.2020.01.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/14/2020] [Accepted: 01/31/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND To investigate the safety of using ABO incompatible (ABO-i) liver grafts in pediatric patients under our prophylactic strategies. METHODS A total number of 544 pediatric liver transplantations between January 2013 and December 2017 performed in Organ Transplant Center, Tianjin First Central Hospital were included in this study. The recipients were divided into 3 groups based on the compatibility of donor-recipient blood type matching (ABO-identical group, n = 352, ABO-compatible group, n = 121 and ABO-incompatible group, n = 71). Recipient characteristics, perioperative data, postoperative complications and recipient survival rate were compared. The recipient outcomes between living-related and non-living-related ABO-incompatible liver graft recipients were also compared. RESULTS The median follow-up time in three groups were 3.4 (1.8, 6.4) years, 3.2 (1.8, 6.1) years and 2.8 (1.8, 6.2) years, without statistical difference. The cumulative 1-year and 3-year graft survival rate were 94.3% and 94.0% in ABO-id group, 93.1% and 93.1% in ABO-c group and 97.1% and 97.1% in ABO-i group. The cumulative 1-year and 3-year recipient survival rate were 96.1% and 95.5% in ABO-id group, 94.8% and 94.8% in ABO-c group and 97.1% and 97.1% in ABO-i group, respectively. No significant difference was seen among three groups. The recipient characteristics and perioperative data were similar among three groups. The recipients in ABO-i group showed significantly lower incidence of portal vein stenosis. Apart from that, three groups shared equal incidence of other surgical complications and acute rejection. Among ABO-i liver graft recipients, the cumulative 1-year and 3-year recipient survival rate were 98.2% and 98.2% in living donor liver transplant (LDLT) recipients and 92.9% and 92.9% in deceased donor liver transplant (DDLT) recipients, without significant difference. The incidence of hepatic artery thrombosis was significantly higher in DDLT group compared with LDLT group, while the other complications were similar between two groups. CONCLUSION Our data revealed that the application of ABO-i liver grafts in pediatric liver transplantation under rational peri-operative management strategy is a safe measure to increase donor availability for pediatric patients in Chinese population. LEVELS OF EVIDENCE III.
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Affiliation(s)
- Chao Sun
- First Central Clinical College of Tianjin Medical University; Organ Transplantation Center, Tianjin First Central Hospital; Tianjin Key Laboratory for Organ Transplantation
| | - Zhuolun Song
- Organ Transplantation Center, Tianjin First Central Hospital; Tianjin Key Laboratory for Organ Transplantation
| | - Nan Ma
- Organ Transplantation Center, Tianjin First Central Hospital; Tianjin Key Laboratory for Organ Transplantation
| | - Xingchu Meng
- Organ Transplantation Center, Tianjin First Central Hospital; Tianjin Key Laboratory for Organ Transplantation
| | - Chong Dong
- Organ Transplantation Center, Tianjin First Central Hospital; Tianjin Key Laboratory for Organ Transplantation
| | - Kai Wang
- Organ Transplantation Center, Tianjin First Central Hospital; Tianjin Key Laboratory for Organ Transplantation
| | - Hong Qin
- Organ Transplantation Center, Tianjin First Central Hospital; Tianjin Key Laboratory for Organ Transplantation
| | - Yang Yang
- Organ Transplantation Center, Tianjin First Central Hospital; Tianjin Key Laboratory for Organ Transplantation
| | - Chao Han
- Organ Transplantation Center, Tianjin First Central Hospital; Tianjin Key Laboratory for Organ Transplantation
| | - Fubo Zhang
- Organ Transplantation Center, Tianjin First Central Hospital; Tianjin Key Laboratory for Organ Transplantation
| | - Wei Gao
- Organ Transplantation Center, Tianjin First Central Hospital; Tianjin Key Laboratory for Organ Transplantation.
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32
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Neto JS, Fonseca EA, Vincenzi R, Pugliese R, Benavides MR, Roda K, Porta G, Miura IK, Porta A, Borges C, Baggio V, Feier FH, Teng H, Rodrigues ML, Iwase FC, Kondo M, Chapchap P. Technical Choices in Pediatric Living Donor Liver Transplantation: The Path to Reduce Vascular Complications and Improve Survival. Liver Transpl 2020; 26:1644-1651. [PMID: 32852894 DOI: 10.1002/lt.25875] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/15/2020] [Accepted: 07/16/2020] [Indexed: 12/11/2022]
Abstract
Pediatric living donor liver transplantation (PLDLT) is a successful therapeutic option for children with chronic and acute liver disease. After early transplant results, many technical advancements were introduced in the field to reduce the rate of complications and improve survival. The aim of this study is to present the outcomes of 975 primary PLDLTs in 3 periods: initial practice (period 1, 29 patients, January 1995 to December 1999), second period (period 2, 331 patients, January 2000 to December 2009), and third period (period 3 [P3], 615 patients, January 2010 to September 2019). Among the technical refinements introduced in P3 are the use of hyperreduced left lateral segment grafts, abdominal wall prosthetic mesh closure, double hepatic artery anastomosis, and increased use of vascular grafts for portal vein reconstruction. The outcomes included significant reductions of hepatic artery thrombosis (HAT), early portal vein thrombosis (EPVT), and retransplantation, with better patient and graft survival in P3. Additional analyses showed that the factors independently associated with worse 90-day patient survival were HAT, EPVT, and increasing Pediatric End-Stage Liver Disease score. In conclusion, the introduction of technical refinements in P3, in addition to improvements in patient care, determined a reduction in EPVT, HAT, and retransplantation. Consequently, patient and graft survival rates increased in all time points studied.
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Affiliation(s)
- João Seda Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Eduardo A Fonseca
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Rodrigo Vincenzi
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Renata Pugliese
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Marcel R Benavides
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Karina Roda
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Gilda Porta
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Irene K Miura
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Adriana Porta
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Christian Borges
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Vera Baggio
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Flavia H Feier
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Hsiang Teng
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Mônica L Rodrigues
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Fernanda C Iwase
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Mário Kondo
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Paulo Chapchap
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
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33
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Chen JL, Chen YL, Qi B, Pan ZY, Lu YF, Zhang W, Zhu J, Yu WF, Song JC, Lu YG. Impact of Intraoperative Norepinephrine Support on Living Donor Liver Transplantation Outcomes: A Retrospective Cohort Study of 430 Children. Front Pharmacol 2020; 11:1254. [PMID: 32922292 PMCID: PMC7456957 DOI: 10.3389/fphar.2020.01254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 07/30/2020] [Indexed: 11/13/2022] Open
Abstract
Norepinephrine (NE) is often administered during the perioperative period of liver transplantation to address hemodynamic instability and to improve organ perfusion and oxygen supply. However, its role and safety profile have yet to be evaluated in pediatric living donor liver transplantation (LDLT). We hypothesized that intraoperative NE infusion might affect pediatric LDLT outcomes. A retrospective study of 430 pediatric patients (median [interquartile range] age, 7 [6.10] months; 189 [43.9%] female) receiving LDLT between 2014 and 2016 at Renji Hospital was conducted. We evaluated patient survival among recipients who received intraoperative NE infusion (NE group, 85 recipients) and those that did not (non-NE group, 345 recipients). The number of children aged over 24 months and weighing more than 10 kg in NE group was more than that in non-NE group. And children in NE group had longer operative time, longer anhepatic phase time and more fluid infusion. After multivariate regression analysis and propensity score regression adjusting for confounding factors to determine the influence of intraoperative NE infusion on patient survival, the NE group had a 169% more probability of dying. Although there was no difference in mean arterial pressure changes relative to the baseline between the two groups, we did observe increased heart rates in NE group compared with those of the non-NE group at anhepatic phase (P=0.025), neohepatic phase (P=0.012) and operation end phase (P=0.017) of the operation. In conclusion, intraoperative NE infusion was associated with a poorer prognosis for pediatric LDLT recipients. Therefore, we recommend the application of NE during pediatric LDLT should be carefully re-considered.
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Affiliation(s)
- Jiang-Long Chen
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,Department of General Surgery, Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan-Li Chen
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bo Qi
- 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
| | - 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
| | - Jiao Zhu
- 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
| | - Jin-Chao Song
- Department of Anesthesiology, Shidong Hospital of Shanghai, University of Shanghai for Science and Technology, Shanghai, China
| | - 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
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34
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Takeda M, Sakamoto S, Irie R, Uchida H, Shimizu S, Yanagi Y, Abdelwahed MS, Fukuda A, Kasahara M. Late T cell-mediated rejection may contribute to poor outcomes in adolescents and young adults with liver transplantation. Pediatr Transplant 2020; 24:e13708. [PMID: 32333637 DOI: 10.1111/petr.13708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 01/31/2020] [Accepted: 03/10/2020] [Indexed: 12/23/2022]
Abstract
Although poor long-term graft survival in LT in AYA is recognized, detailed epidemiological data are still lacking. L-TCMR may have poor outcomes. This study aimed to provide a detailed, epidemiological assessment of the association between AYA age and rejection. L-TCMR was defined in this study as TCMR with central vein or perivenular inflammation occurring later than 3 months after LT. A total of 342 patients who survived for at least 3 months after LT between 2005 and 2015 were enrolled. The AYA group (10-24 years) was compared with the C group (less than 10 years), and the incidence and outcomes of L-TCMR were analyzed. In total, 342 patients had LT; 38 of these were AYA with the mean follow-up period of 6.7 years. A total of 304 patients in C group had a mean follow-up period of 6.3 years (P = .28). The incidence of L-TCMR in AYA group was significantly higher than in C group (15.8% vs 4.6%, P = .006). The time to L-TCMR after LT was significantly shorter in AYA group (P = .01). Neither patient survival nor the incidence of non-adherence differed significantly between the groups (P = .18 and P = .89). The number of additional immunosuppressants after L-TCMR was significantly higher in the AYA group (P = .04). A high incidence of L-TCMR was observed in AYA group irrespective of non-adherence. AYA patients with L-TCMR should be followed carefully due to the poor results of post-treatment biopsy and the need for intensive immunosuppressive therapy.
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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
| | - Rie Irie
- Department of Pathology, National Center for Child Health and Development, Tokyo, Japan
| | - Hajime Uchida
- 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
| | - Yusuke Yanagi
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Mohamed Sami Abdelwahed
- 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
| | - Mureo Kasahara
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
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35
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Pan ZY, Fan YC, Wang XQ, Chen LK, Zou QQ, Zhou T, Qiu BJ, Lu YF, Shen CH, Yu WF, Luo Y, Su DS. Pediatric living donor liver transplantation decade progress in Shanghai: Characteristics and risks factors of mortality. World J Gastroenterol 2020; 26:1352-1364. [PMID: 32256022 PMCID: PMC7109279 DOI: 10.3748/wjg.v26.i12.1352] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/17/2020] [Accepted: 02/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pediatric living donor liver transplantation (LDLT) has become the gold standard for patients with end-stage liver disease. With improvements in organ preservation, immunosuppression, surgical and anesthesia techniques, the survival rates and long-term outcomes of patients after LDLT have significantly improved worldwide. However, data on anesthetic management and postoperative survival rate of pediatric LDLT in China are rare.
AIM To review the status of pediatric LDLT in Shanghai and investigate the factors related to anesthetic management and survival rate in pediatric LDLT.
METHODS We conducted a retrospective observational study to investigate the status of pediatric LDLT in Shanghai by reviewing 544 records of patients who underwent pediatric LDLT since the first operation on October 21, 2006 until August 10, 2016 at Renji Hospital and Huashan Hospital.
RESULTS The 30-d, 90-d, 1-year, and 2-year survival rates were 95.22%, 93.38%, 91.36%, and 89.34%, respectively. The 2-year patient survival rate after January 1, 2011 significantly improved compared with the previous period (74.47% vs 90.74%; hazard ratio: 2.92; 95% confidence interval (CI): 2.16–14.14; P = 0.0004). Median duration of mechanical ventilation in the intensive care unit (ICU) was 18 h [interquartile range (IQR), 15.25–20.25], median ICU length of stay was 6 d (IQR: 4.80–9.00), and median postoperative length of stay was 24 d (IQR: 18.00–34.00). Forty-seven (8.60%) of 544 patients did not receive red blood cell transfusion during the operation.
CONCLUSION Pediatric end-stage liver disease (PELD) score, anesthesia duration, operation duration, intraoperative blood loss, and ICU length of stay were independent predictive factors of in-hospital patient survival. Pediatric end-stage liver disease score, operation duration, and ICU length of stay were independent predictive factors of 1-year and 3-year patient survival.
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Affiliation(s)
- Zhi-Ying Pan
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Yi-Chen Fan
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Xiao-Qiang Wang
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Ling-Ke Chen
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Qiao-Qun Zou
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Tao Zhou
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Bi-Jun Qiu
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Ye-Feng Lu
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Cong-Huan Shen
- Department of Liver Transplantation, Huashan Hospital, School of Medicine, Shanghai Fudan University, Shanghai 200040, China
| | - Wei-Feng Yu
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Yi Luo
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Dian-San Su
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
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36
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Goldaracena N, Echeverri J, Kehar M, DeAngelis M, Jones N, Ling S, Kamath BM, Avitzur Y, Ng VL, Cattral MS, Grant DR, Ghanekar A. Pediatric living donor liver transplantation with large-for-size left lateral segment grafts. Am J Transplant 2020; 20:504-512. [PMID: 31550068 DOI: 10.1111/ajt.15609] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/26/2019] [Accepted: 09/03/2019] [Indexed: 02/07/2023]
Abstract
Usage of "large-for-size" left lateral segment (LLS) liver grafts in children with high graft to recipient weight ratio (GRWR) is controversial due to concerns about increased recipient complications. During the study period, 77 pediatric living donor liver transplantations (LDLTs) with LLS grafts were performed. We compared recipients with GRWR ≥2.5% (GR-High = 50) vs GRWR <2.5% (GR-Low = 27). Median age was higher in the GR-Low group (40 vs 8 months, P> .0001). Graft (GR-High: 98%, 98%, 98% vs GR-Low: 96%, 93%, 93%) and patient (GR-High: 98%, 98%, 98% vs GR-Low: 100%, 96%, 96%) survival at 1, 3, and 5 years was similar between groups (P = NS). Overall complications were also similar (34% vs 30%; P = .8). Hepatic artery and portal vein thrombosis following transplantation was not different (P = NS). Delayed abdominal fascia closure was more common in GR-High patients (17 vs 1; P = .002). Subgroup analysis comparing recipients with GRWR ≥4% (GR-XL = 20) to GRWR <2.5% (GRWR-Low = 27) revealed that delayed abdominal fascia closure was more common in the GR-XL group, but postoperative complications and graft and patient survival were similar. We conclude that pediatric LDLT with large-for-size LLS grafts is associated with excellent clinical outcomes. There is an increased need for delayed abdominal closure with no compromise of long-term outcomes. The use of high GRWR expands the donor pool and improves timely access to the benefits of transplantation without extra risks.
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Affiliation(s)
- Nicolas Goldaracena
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, University Health Network, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada.,Division of Transplant Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Juan Echeverri
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, University Health Network, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Mohit Kehar
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada.,Liver Transplant Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maria DeAngelis
- Liver Transplant Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicola Jones
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada.,Liver Transplant Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Simon Ling
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada.,Liver Transplant Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Binita M Kamath
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada.,Liver Transplant Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yaron Avitzur
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada.,Liver Transplant Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vicky L Ng
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada.,Liver Transplant Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark S Cattral
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, University Health Network, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada.,Liver Transplant Program, Hospital for Sick Children, Toronto, Ontario, Canada.,Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - David R Grant
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, University Health Network, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada.,Liver Transplant Program, Hospital for Sick Children, Toronto, Ontario, Canada.,Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anand Ghanekar
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, University Health Network, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada.,Liver Transplant Program, Hospital for Sick Children, Toronto, Ontario, Canada.,Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
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Gao W, Song Z, Ma N, Dong C, Sun C, Meng X, Zhang W, Wang K, Wu B, Li S, Qin H, Han C, Li H, Shen Z. Utility of neonatal donors in pediatric liver transplantation: A single-center experience. Pediatr Transplant 2019; 23:e13396. [PMID: 31081216 DOI: 10.1111/petr.13396] [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: 05/30/2018] [Revised: 11/07/2018] [Accepted: 01/28/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The lack of age- and size-matched organs result in higher waiting list mortality in pediatric recipients than adults. Organs from deceased newborns and infants are a valuable source to increase donor pool in pediatric liver transplantation. However, the feasibility and safety of using neonatal donors have not been well evaluated. METHODS From 2014 to 2016, 48 deceased donor pediatric liver transplantations with donor age younger than 1 year old in our center were enrolled in this study. The recipients were divided into three groups based on the donor age (<1 month, 1 month ≤ to <3 months, and 3 months ≤ to <1 year). Recipient's characteristics, perioperative data, and postoperative complications were compared. RESULTS Two-year patient survival rates were 87.5%, 94.4%, and 95.5%, and 2-year graft survival rates were 75%, 94.4%, and 95.5%, respectively, without significant difference. The liver grafts from donors younger than 3 months were more advantageous in terms of acute rejection and virus infection, while the young grafts were related to slight higher incidence of hepatic artery thrombosis and SFSS. Those complications could be effectively prevented or treated by our perioperative care strategies. In addition, eight recipients who received neonatal livers achieved comparable outcomes with recipients with older livers. CONCLUSION Our data revealed that the application of liver grafts from donors younger than 1 year old could achieve excellent outcome. In particular, neonatal donors could be safely used in well-selected patients.
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Affiliation(s)
- Wei Gao
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Zhuolun Song
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Nan Ma
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Chong Dong
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Chao Sun
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Xingchu Meng
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Wei Zhang
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Kai Wang
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Bin Wu
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Shanni Li
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Hong Qin
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Chao Han
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Haohao Li
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Zhongyang Shen
- Liver Transplantation Department, Tianjin First Center Hospital, Tianjin, China.,Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
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38
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Zhan J, Chen Y, Wong KKY. How to evaluate diagnosis and management of biliary atresia in the era of liver Transplantation in China. WORLD JOURNAL OF PEDIATRIC SURGERY 2018. [DOI: 10.1136/wjps-2018-000002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundBiliary atresia (BA) is one of the most challenging hepatobiliary diseases in children. Notwithstanding the reasonable outcome of liver transplantation (LT), portoenteral anastomosis (Kasai operation) is still the first choice of treatment for patients with BA. How to improve the survival rate of the patients with BA in the era of LT is a new challenge.Data sourcesBased on recent original publications and the experience with the BA in China, we review many factors that influence BA survival situation, including early diagnosis and screen plan, defects of early treatment, Kasai operation, and LT and indicate present questions about BA diagnosis and treatment in China.ResultsBA diagnosis may also be delayed due to insufficient understanding of BA and lack of jaundice monitoring methods at different levels of the hospitals in China. Further education of the physicians at smaller city hospitals about BA, neonatal jaundice and cholestasis would be helpful in improving early diagnosis of BA. Early surgical intervention is still the only guarantee to improve the survival rate of BA with native liver.ConclusionsIn the era of LT, especially in China, Kasai operation can provide waiting time for living donor LT and improve the success rate of LT and minimize the rapid deterioration of liver function of the children with BA and decrease the mortality in patients with BA.
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Mysore KR, Himes RW, Rana A, Teruya J, Desai MS, Srivaths PR, Zaruca K, Calvert A, Guffey D, Minard CG, Morita E, Hensch L, Losos M, Kostousov V, Hui SKR, Orange JS, Goss JA, Nicholas SK. ABO-incompatible deceased donor pediatric liver transplantation: Novel titer-based management protocol and outcomes. Pediatr Transplant 2018; 22:e13263. [PMID: 30070010 PMCID: PMC6197909 DOI: 10.1111/petr.13263] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 06/18/2018] [Indexed: 12/16/2022]
Abstract
ABO-ILT have re-emerged as an alternate option for select patients awaiting transplant. However, treatment protocols for children undergoing deceased donor ABO-ILT are not standardized. We implemented a novel IS protocol for children undergoing deceased donor ABO-ILT based on pretransplant IH titers. Children with high pretransplant IH titers (≥1:32) underwent an enhanced IS protocol including plasmapheresis, rituximab, IVIG, and mycophenolate, while children with IH titers ≤1:16 received steroids and tacrolimus. We retrospectively assessed our outcomes of ABO-ILT with ABO-compatible recipients of similar age and diagnosis over a 2-year period. Ten children with median age of 8.9 months underwent ABO-ILT, 4 of 10 patients underwent enhanced IS due to high IH titers. Rates of complications (rejection, infections, biliary, and vascular) at both 1 year and up to 3 years post-transplant were comparable between the groups. Patients with ABO-ILT had good graft function with 100% survival at a median follow-up of 3.3 years. In conclusion, IS tailored to pretransplant IH titers in pediatric deceased donor ABO-ILT is feasible and can achieve outcomes similar to ABO-CLT at 1 and 3 years post-transplantation.
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Affiliation(s)
- Krupa R. Mysore
- Section of Pediatric Gastroenterology, Texas Children’s Hospital, Baylor College of Medicine
| | - Ryan W. Himes
- Section of Pediatric Gastroenterology, Texas Children’s Hospital, Baylor College of Medicine
| | - Abbas Rana
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine
| | - Jun Teruya
- Department of Pathology, Transfusion Medicine, Baylor College of Medicine
| | - Moreshwar S. Desai
- Section of Pediatric Critical Care, Texas Children’s Hospital, Baylor College of Medicine
| | | | - Kimberly Zaruca
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine
| | | | - Danielle Guffey
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine
| | - Charles G. Minard
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine
| | - Eda Morita
- Department of Pathology, Transfusion Medicine, Baylor College of Medicine
| | - Lisa Hensch
- Department of Pathology, Transfusion Medicine, Baylor College of Medicine
| | - Michael Losos
- Department of Pathology, Transfusion Medicine, Baylor College of Medicine
| | - Vadim Kostousov
- Department of Pathology, Transfusion Medicine, Baylor College of Medicine
| | - Shiu-Ki Rocky Hui
- Department of Pathology, Transfusion Medicine, Baylor College of Medicine
| | - Jordan S. Orange
- Section of Pediatric Allergy & Immunology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - John A. Goss
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine
| | - Sarah K. Nicholas
- Section of Pediatric Allergy & Immunology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
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40
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Jagadisan B, Jalan A, Dhawan A. Challenging the flow of conventional wisdom-liver transplantation across blood group barriers. Pediatr Transplant 2018; 22:e13284. [PMID: 30345610 DOI: 10.1111/petr.13284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Barath Jagadisan
- Paediatric Liver GI and Nutrition center and Mowat Labs, King's College Hospital, London, UK
| | - Aarti Jalan
- Paediatric Liver GI and Nutrition center and Mowat Labs, King's College Hospital, London, UK
| | - Anil Dhawan
- Paediatric Liver GI and Nutrition center and Mowat Labs, King's College Hospital, London, UK
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41
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Angelico R, Nardi A, Adam R, Nadalin S, Polak WG, Karam V, Troisi RI, Muiesan P. Outcomes of left split graft transplantation in Europe: report from the European Liver Transplant Registry. Transpl Int 2018; 31:739-750. [PMID: 29505674 DOI: 10.1111/tri.13147] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/19/2017] [Accepted: 02/27/2018] [Indexed: 02/07/2023]
Abstract
Split liver transplantation (SLT) has been widely adopted across Europe, resulting in remarkable reduction in the paediatric waiting-list mortality. Left split graft (LSG) is commonly used for paediatric recipients; however, deceased donor criteria selection are not universal. The aim of this study was to analyse the LSG outcome from the European Liver Transplant Registry and to identify risk factors for graft failure. Data from 1500 children transplanted in 2006-2014 with LSG from deceased donors were retrospectively analysed. Overall, graft losses were 343(22.9%) after 5 years from transplantation, 240(70.0%) occurred within the first 3 months. Estimated patient survival was 89.1% at 3 months and 82.9% at 5 years from SLT. Re-transplantation rate was 11.5%. At multivariable analysis, significant risk factors for graft failure at 3 months included the following: urgent SLT (HR = 1.73, P = 0.0012), recipient body weight ≤6 kg (HR = 1.91, P = 0.0029), donor age >50 years (HR = 1.87, P = 0.0039), and cold ischaemic time (CIT) [HR = 1.07 per hour, P = 0.0227]. LSG has good outcomes and SLT is excellent option for paediatric recipients in the current organ shortage era. We identified practical guidelines for LSG donor and recipient selection criteria: donor age may be safely extended up to 50 years in the absence of additional risk factors; thus, children <6 kg and urgent transplantation need CIT <6 h and appropriate graft/recipient size-matching to achieve good outcomes.
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Affiliation(s)
- Roberta Angelico
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | - Alessandra Nardi
- Department of Mathematics, University of Rome Tor Vergata, Rome, Italy
| | - René Adam
- Department of Hepatobiliary Surgery, Cancer and Transplantation, AP-HP AT, Hôpital Universitaire Paul Brousse, Université Paris-Sud, Villejuif, France
| | - Silvio Nadalin
- Department of General, Vascular and Transplant Surgery, University of Tuebingen, Tubingen, Germany
| | - Wojciech G Polak
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent Karam
- Department of Hepatobiliary Surgery, Cancer and Transplantation, AP-HP AT, Hôpital Universitaire Paul Brousse, Université Paris-Sud, Villejuif, France
| | - Roberto I Troisi
- Department of General Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital Medical School, Ghent, Belgium
| | - Paolo Muiesan
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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