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Martinez M, Kang E, Beltramo F, Nares M, Jeyapalan A, Alcamo A, Monde A, Ridall L, Kamath S, Betters K, Rowan C, Mangus RS, Kaushik S, Zinter M, Resch J, Maue D. Vascular thrombosis after pediatric liver transplantation: Is prevention achievable? JOURNAL OF LIVER TRANSPLANTATION 2023; 12:100185. [PMID: 38037556 PMCID: PMC10686788 DOI: 10.1016/j.liver.2023.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Background Vascular thromboses (VT) are life-threatening events after pediatric liver transplantation (LT). Single-center studies have identified risk factors for intra-abdominal VT, but large-scale pediatric studies are lacking. Methods This multicenter retrospective cohort study of isolated pediatric LT recipients assessed pre- and perioperative variables to determine VT risk factors and anticoagulation-associated bleeding complications. Results Within seven postoperative days, 31/331 (9.37%) patients developed intra-abdominal VT. Open fascia occurred more commonly in patients with VT (51.61 vs 23.33%) and remained the only independent risk factor in multivariable analysis (OR = 2.84, p = 0.012). Patients with VT received more blood products (83.87 vs 50.00%), had significantly higher rates of graft loss (22.58 vs 1.33%), infection (50.00 vs 20.60%), and unplanned return to the operating room (70.97 vs 16.44%) compared to those without VT. The risk of bleeding was similar (p = 0.2) between patients on and off anticoagulation. Conclusions Prophylactic anticoagulation did not increase bleeding complications in this cohort. The only independent factor associated with VT was open fascia, likely a graft/recipient size mismatch surrogate, supporting the need to improve surgical techniques to prevent VT that may not be modifiable with anticoagulation.
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Affiliation(s)
- Mercedes Martinez
- Columbia University Irving Medical Center, Department of Pediatrics, New York, USA
| | - Elise Kang
- Columbia University Irving Medical Center, Department of Pediatrics, New York, USA
| | - Fernando Beltramo
- Children’s Hospital of Los Angeles, Department of Anesthesiology Critical Care, Los Angeles, USA
| | - Michael Nares
- University of Miami Miller School of Medicine, Department of Pediatrics, Miami, USA
| | - Asumthia Jeyapalan
- University of Miami Miller School of Medicine, Department of Pediatrics, Miami, USA
| | - Alicia Alcamo
- Children’s Hospital of Philadelphia, Department of Critical Care Medicine, Philadelphia, USA
| | - Alexandra Monde
- Georgetown University Hospital, Department of Pediatrics, Washington DC, USA
| | - Leslie Ridall
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, USA
| | - Sameer Kamath
- Duke University, Department of Pediatrics, Durham, USA
| | | | - Courtney Rowan
- Indiana University School of Medicine, Department of Pediatrics, Indianapolis, USA
| | | | - Shubhi Kaushik
- Mount Sinai School of Medicine, Department of Pediatrics, New York, USA
- Children’s Hospital at Montefiore, New York, USA
| | - Matt Zinter
- University of California San Francisco, Department of Pediatrics, San Francisco, USA
| | - Joseph Resch
- University of Minnesota, Department of Pediatrics, Minneapolis, USA
| | - Danielle Maue
- Indiana University School of Medicine, Department of Pediatrics, Indianapolis, USA
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Lopez-Verdugo F, Sanchez-Garcia J, Baraki S, Kastenberg ZJ, Sanchez-Garavito JE, Zendejas I, Alonso D, Jensen MK, Fujita S, Meyers RL, Book L, Rodriguez-Davalos MI. Utilization of Segmental Grafts Is Associated With Higher Transplant Rates in Pediatric Patients. J Surg Res 2023; 290:28-35. [PMID: 37178557 DOI: 10.1016/j.jss.2023.03.048] [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: 08/11/2022] [Revised: 03/03/2023] [Accepted: 03/26/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION In July 2017, a policy to increase the use of segmental grafts (SGs) was implemented at our institution. The aim was to compare changes in waitlist activity after implementation of this policy. METHODS A single-center, retrospective study. Pediatric patients on the liver waiting list between January 2015 and December 2019 were screened. Patients were classified as receiving a liver transplant (LT) before (Period 1) or after (Period 2) policy changes. Primary end points were transplant rates and time to transplant. RESULTS Sixty five first LT performed on 65 patients were included. Twenty nine LT were performed during Period 1 and 36 during Period 2. More than half (55%) of LT in Period 2 were SG, compared to 10.3% in Period 1 (P < 0.001). Forty nine and 56 pediatric candidates on the waiting list accounted for 38.78 and 24.48 person-years during Period 1 and Period 2, respectively. Transplant rates per 100 person-years on the waiting list increased from 85.09 during Period 1 to 187.87 in Period 2 (Rate ratio: 2.20; P < 0.001). Median time to receive a LT decreased from 229 d in Period 1 to 75 d during Period 2 (P = 0.013). One-year patient survival rates were 96.6% in Period 1 and 95.7% in Period 2. One-year graft survival rates were 89.7% and 88% in Period 1 and Period 2, respectively. CONCLUSIONS A policy to increase the use of SG was associated with significantly higher transplant rates and lower waiting times. Implementation of this policy can be done successfully with no observed negative impact on patient and graft survival.
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Affiliation(s)
- Fidel Lopez-Verdugo
- Liver Center, Primary Children's Hospital, Salt Lake City, Utah; Transplant Services, Intermountain Medical Center, Salt Lake City, Utah
| | - Jorge Sanchez-Garcia
- Liver Center, Primary Children's Hospital, Salt Lake City, Utah; Transplant Services, Intermountain Medical Center, Salt Lake City, Utah
| | - Shanni Baraki
- Liver Center, Primary Children's Hospital, Salt Lake City, Utah
| | - Zachary J Kastenberg
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Ivan Zendejas
- Liver Center, Primary Children's Hospital, Salt Lake City, Utah; Transplant Services, Intermountain Medical Center, Salt Lake City, Utah
| | - Diane Alonso
- Liver Center, Primary Children's Hospital, Salt Lake City, Utah; Transplant Services, Intermountain Medical Center, Salt Lake City, Utah
| | - M Kyle Jensen
- Liver Center, Primary Children's Hospital, Salt Lake City, Utah; Department of Pediatrics, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - Shiro Fujita
- Liver Center, Primary Children's Hospital, Salt Lake City, Utah; Transplant Services, Intermountain Medical Center, Salt Lake City, Utah
| | - Rebecka L Meyers
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Linda Book
- Liver Center, Primary Children's Hospital, Salt Lake City, Utah; Department of Pediatrics, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - Manuel I Rodriguez-Davalos
- Liver Center, Primary Children's Hospital, Salt Lake City, Utah; Transplant Services, Intermountain Medical Center, Salt Lake City, Utah.
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Wang Z, Gao W, Dong C, Sun C, Wang K, Zhang W, Song Z, Qin H, Han C, Yang Y, Zhang F, Xu M, Zheng W, Shen Z. Outcome of split-liver transplantation from pediatric donors weighing 25 kg or less. Liver Transpl 2023; 29:58-66. [PMID: 35715984 DOI: 10.1002/lt.26530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 05/28/2022] [Accepted: 06/11/2022] [Indexed: 01/14/2023]
Abstract
The lower limit of body weight for "splitable" liver grafts remains unknown. To examine the outcome of split-liver transplantation (SLT) from pediatric donors ≤25 kg relative to conventional graft-type liver transplantation from deceased donors under corresponding conditions, a total of 158 patients who received primary liver transplantation, including 22 SLTs from donors ≤25 kg, 46 SLTs from donors >25 kg, 76 whole-liver transplantations, and 14 reduced-liver transplantations in donors ≤25 kg between January 2018 and December 2019, were included in the study. There was no significant difference in the complications, patient survival, and graft survival between each of the latter three groups and the SLT ≤25 kg group. Pediatric End-Stage Liver Disease (PELD) score was the independent predictor of graft loss (death or retransplantation). Graft weight was the independent predictor of hepatic artery thrombosis. SLT using well-selected pediatric donors ≤25 kg is an effective strategy to increase organ availability, especially for low-body-weight recipients, compared with conventional graft type from deceased donors under the condition of corresponding donor weight without increasing morbidity and mortality.
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Affiliation(s)
- Zhen Wang
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Wei Gao
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China.,Tianjin Key Laboratory of Organ Transplantation , Tianjin , China
| | - Chong Dong
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Chao Sun
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Kai Wang
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Wei Zhang
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Zhuolun Song
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Hong Qin
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Chao Han
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Yang Yang
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Fubo Zhang
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Min Xu
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Weiping Zheng
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China
| | - Zhongyang Shen
- Department of Pediatric Transplantation, Organ Transplantation Center , Tianjin First Central Hospital , Tianjin , China.,Tianjin Key Laboratory of Organ Transplantation , Tianjin , China
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