Pediatric living-donor liver transplantation using right posterior segment grafts

Background

The right posterior segment (RPS) graft was introduced to overcome graft size discrepancy in living donor liver transplantation (LDLT). However, it was very rarely used in pediatric patients. Here we presented 4 pediatric LDLT cases receiving RPS graft between January 2015 and April 2020 in our center. A total of 1868 LDLT procedures were performed in this period.

Methods

Recipients included 1 boy and 3 girls with a median age of 45 months (range from 40 to 93 months). They were diagnosed with progressive familial intrahepatic cholestasis, propionic academia, ornithine transcarbamylase and biliary atresia, respectively. Four donors were all mothers with a median age of 32.5 years (31–38 years). Computer tomography angiography indicated posterior right branches branched off separately from main portal veins (type III variation). Three of these donor livers had 1 orifice of right hepatic veins (RHV). In the remaining 1 donor liver, the RHV showed 3 orifices and an outflow patch plastic was performed. Inferior right hepatic veins weren’t found in four donor grafts. The median graft weight was 397.5 g (352–461 g) and the median graft-to-recipient weight ratio was 2.38% (1.44–2.80%).

Results

Postoperative complications occurred in neither donors nor recipients. Within the median follow-up duration of 29 months (14–64 months), four children are all alive with normal liver function.

Conclusion

In summary, for older children weighed more than 15 kg with donors’ variation of type III portal veins, the use of RPS grafts could be a feasible and favorable option.

Right posterior segment graft in living donor liver transplantation

AIM

Living donor liver transplantation (LDLT) is widely performed for end-stage liver disease. Liver volume is important for donor safety and recipient survival. In adult-to-adult LDLT, left lobe graft is frequently insufficient for the recipient, while right lobe graft carries a higher donor risk. The right posterior segment graft (RPSG) was introduced to increase donor selection options. However, only a few institutions have reported LDLT with an RPSG.

METHODS

In total, 587 adult recipients underwent LDLT at Kyoto University Hospital from 2001 to 2011. Here, we retrospectively report 14 LDLT with RPSG. All donors underwent volumetric analyses and detailed investigation of the hepatic vein (HV), portal vein (PV), hepatic artery (HA) and biliary duct (BD). Anatomical anomalies were detected in four donors' BD. The mean Model for End-Stage Liver Disease score was 22.6 ± 12.4 points. ABO blood groups were characterized as incompatible in three cases. The mean graft-to-recipient weight ratio was 0.897 ± 0.203.

RESULTS

Donors' postoperative courses were uneventful. To adjust diameters and lengths between grafts and recipients, dual anastomoses for PV reconstruction and graft interpositions for PV and HA reconstruction were required in one case each. HA thrombosis occurred in two cases and PV thrombosis in one. Biliary complications occurred in two cases. Though there was no significant difference in survival following RPSG versus other grafts, critical complications were observed in recipients.

CONCLUSION

The RPSG is a useful option in LDLT. However, careful consideration is required for RPSG harvest and LDLT performance, both before and during surgery.

Liver transplantation from living donors with Gilbert's syndrome is a safe procedure for both donors and recipients

Liver transplantation (LT) has become a favorable therapeutic option for patients with end-stage liver diseases. Gilbert's syndrome (GS) is a benign condition characterized by intermittent mild jaundice due to unconjugated hyperbilirubinemia. It is not obvious whether living-donor liver transplantation (LDLT) from a donor with GS could result in a normal outcome for both the recipient and the donor. We aimed to determine whether right lobe hepatectomy is a safe procedure for living donors with GS and LT recipients. Between September 2011 and March 2015, 305 LDLT procedures using right lobe grafts were performed at Atasehir Memorial Hospital, Istanbul, Turkey. Nineteen of 305 LT candidates who had been diagnosed with GS were included in the current study. After a 12-h overnight fast, total and indirect bilirubin levels of donors and recipients were measured. The median follow-up after transplant was 16 months (range 3-36 months). The median age of donors was 25 (range 20-55 yr). Four donors (21%) were female, and 15 donors (89%) were male. The median age of donors was 51 (range 23-68 yr). Eleven recipients (57%) were female, and 8 (43%) were male. The median preoperative total bilirubin level of donors was 1.69 mg/dL (range 1.26-2.43 mg/dL) (normal range <1.2 mg/dL). The median total bilirubin level of donors on postoperative day 7 was 1.04 mg/dL (range 0.71-3.23 mg/dL). As our study has included a large number of donors with GS, it produced reliable evidence that right lobe hepatectomy is a safe procedure for living donors with GS and LT recipients.

[Hospital-based multicenter study in Spain, Mexico and Cuba on attitudes to living liver donation]

INTRODUCTION

Given the lack of a sufficient number of livers available for transplantation, living liver donation (LLD) is being developed in the Spanish-speaking world. To do this, it is essential that health workers in hospitals are in favor of such donation, given that they are a key component in this treatment and that their attitudes influence public opinion.

OBJECTIVE

To analyze attitude toward LLD among hospital personnel from healthcare centers in Spain and Latin America.

MATERIAL AND METHOD

Ten hospitals were selected from the «International Donor Collaborative Project»: 3 from Spain, 5 from Mexico and 2 from Cuba. Random sampling stratified by type of service and job category was used. Attitudes to LLD were evaluated through a validated questionnaire on psychosocial aspects. The questionnaire was anonymous and self-administered. Statistical tests consisted of Student's T test, the chi-square test and logistic regression analysis.

RESULTS

Of the 2,618 employees surveyed, 85% (n=2,231) were in favor of related LLD; of these, 31% (n=804) were in favor of unrelated LLD. No association was found between the country of the interviewed, personal-social variables or work-related variables. The following factors were associated with a favorable attitude toward related LLD donation: having had personal experience of donation and transplantation (P<.001); being in favor of deceased donation (P<.001); believing that one might need a possible transplant (P<.001); being in favor of living kidney donation (P<.001); being willing to accept a liver from a living donor (P<.001); having discussed the matter of donation and transplantation within the family (P<.001) and with one's partner (P<.001); carrying out pro-social type activities (P<.001); being Catholic (P=.040); believing that one's religion is in favor of donation and transplantation (P<.001); and not being concerned about the possible mutilation of the body after donation (P<.001).

CONCLUSIONS

Hospital personnel from Spain and Latin America had a favorable attitude toward LLD, which was associated with factors directly and indirectly related to donation and transplantation, family and religious factors, and attitudes toward the body.

Opinion toward living liver donation of hospital personnel from units related to organ donation and transplantation: a multicenter study from Spain and latin-america

BACKGROUND

Hospital personnel of services related to donation and transplantation process play a fundamental role in the development of transplantation.

OBJECTIVES

The aim of this study was to investigate the attitude toward living liver donation (LLD) among hospital personnel from services related to donation and transplantation in hospital centers in Spain and Latin America.

MATERIALS AND METHODS

Eight hospitals within the "International Donor Collaborative Project" were selected, three in Spain, three in Mexico and two in Cuba. The study was performed in transplant-related services, using a randomized sample, which was stratified by the type of service and job category.

RESULTS

In total, 878 workers were surveyed of which 82% (n = 720) were in favor of related LLD, 10% (n = 90) were against and 8% (n = 68) undecided. Attitudes toward related LLD were more favorable in the following groups: the Latin Americans (86% in favor vs. 77% among the Spanish; P = 0.007); younger people (37 vs. 40 years, P = 0.002); those in favor of either deceased donation (P < 0.001) or living kidney donation (P < 0.001); those who believed that they might need a transplant in the future (P < 0.001); those who would accept a liver from a living donor (P < 0.001); those who discussed the subject of donation and transplantation with their families (P = 0.040); and those whose partner was in favor of donation and transplantation (P = 0.044).

CONCLUSIONS

Personnel from donation and transplantation-related units had a favorable attitude toward LLD. This attitude was not affected by psychosocial factors, although it was influenced by factors directly and indirectly related to the donation and transplantation process.

Impact of intra-operative cholangiography and parenchymal resection to donor liver function in living donor liver transplantation

BACKGROUND

Living donor liver transplantation (LDLT) has been widely accepted over the past decade, and hepatic dysfunction often occurs in the donor in the early stage after liver donation. The present study aimed to evaluate the effect of intra-operative cholangiography (IOC) and parenchymal resection on liver function of donors in LDLT, and to assess the role of IOC in influencing the biliary complications and improving the overall outcome.

METHODS

Data from 40 patients who had donated their right lobes for LDLT were analyzed. Total bilirubin (TB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT) at different time points were compared, and the follow-up data and the biliary complications were also analyzed.

RESULTS

The ALT and AST values were significantly increased after IOC (P<0.001) and parenchymal resection (P<0.001). However, the median values of TB, ALP and GGT were not significantly influenced by IOC (P>0.05) or parenchymal resection (P>0.05). The biochemical changes caused by IOC or parenchymal resection were not correlated with the degree of post-operative liver injury or the recovery of liver function. The liver functions of the donors after operation were stable, and none of the donors suffered from biliary stenosis or leakage during the follow-up.

CONCLUSIONS

IOC and parenchymal resection may induce a transient increase in liver enzymes of donors in LDLT, but do not affect the recovery of liver function after operation. Moreover, the routine IOC is helpful to clarify the division line of the hepatic duct, thus reducing the biliary complication rate.

Donor quality of life up to two years after living donor liver transplantation: a prospective study

BACKGROUND

There is a lack of longer-term prospective data on living liver donors' quality of life (QOL). This is the first prospective study examining QOL up to 2 years after donation.

METHODS

A consecutive sample of living donors (n=40) was compared with a sample of potential donors (n=27) with respect to QOL, anxiety, and depression. Performing mixed-effects model analysis, both groups were assessed before transplantation, with and without simultaneous donation (T0), and at three postoperative data points: 3 months (T1), 1 year (T2), and 2 years (T3). Subsequently, both groups were compared with reference data of the general population and healthy individuals.

RESULTS

At T1, living donors' physical QOL was impaired. At T2 and T3, physical QOL was slightly lower than the preoperative level but within the range of healthy individuals in both living donors and potential donors. Neither mental QOL nor depression showed significant changes across time, while anxiety decreased in both groups. Subgroup analysis of adult-to-adult (AA) donors and adult-to-pediatric (AP) donors revealed different trajectories of mental QOL, anxiety, and depression. AP donors experienced more preoperative psychological strain, which improved after donation, whereas AA donors showed unchanged anxiety and depression, and a slight decrease in mental QOL 2 years after surgery. Two AA donors, whose recipients had died, reported persisting depressive symptoms after donation.

CONCLUSIONS

One and two years after donation, QOL is not substantially impaired in the majority of donors. Future research needs to provide an even longer prospective follow-up and should more rigorously explore risk factors for a negative donor outcome.

Difference in outcomes between living left lobe donors and noncirrhotic subjects undergoing left lobe resections

OBJECTIVES

The aim of this study was to compare short- and long-term outcomes between the living donors and patients without cirrhosis after left lobe resection.

MATERIAL AND METHODS

We retrospectively collected data from 40 left lobe donors (Group 1) and from 40 patients who had undergone left liver resection for various diseases (Group 2) from 2002 to 2010. In addition to preoperative parameters, we compared intraoperative variables as well as, short- and long-term outcomes, including postoperative complications and laboratory test results. The liver functions included total bilurubin (TB), aspartate aminotransferase (AST), alanine aminotransferase (ALT), international normalized ratio (INR), and albumin (ALB) compared as well as changes in white blood cell (WBC) count and platelet count.

RESULTS

The preoperative parameters of the two groups were comparable. There was significantly more blood loss in Group 2 than Group 1 (422.5 mL vs 318.8 mL; P = .001), leading to more autologous blood transfusions in Group 2 (P = .008). The other intraoperative variables were similar between the two groups. The overall postoperative complication rate was similar: 4% in Group 1 and 8% in Group 2 (P = .213); however, there were longer hospital stays and overall costs in Group 1 (P < .05). The total bilirubin level, AST, and ALT of Group 2 were worse than those in Group 1 during the early postoperative period. Upon long-term follow-up the postoperative platelet count decreased in the two groups compared with the preoperative levels.

CONCLUSION

The type and rate of complications following left hepatectomy were similar between donors and noncirrhotic hepatic patients. Nevertheless, more serious liver dysfunction postoperatively was observed among the patient group.

[Attitudes among Spanish and Latin American non-medical health professionals to living donor liver transplantation]

INTRODUCTION

Hospital professionals are an opinion group that influences the general population.

OBJECTIVE

To analyze attitudes to living donor liver transplantation (LDLT) among non-medical professionals working in Spanish and Latin American hospitals and to determine the variables that influence these attitudes.

MATERIAL AND METHOD

A random sample, stratified by department, was selected from non-medical staff in the "International Donor Collaborative Project": there were three hospitals in Spain, five in Mexico and two in Cuba. Attitudes were evaluated through a validated, anonymous, self-administered questionnaire.

RESULTS

There were 951 non-medical professionals: 277 from Spain, 632 from Mexico and 42 from Cuba. A total of 86% (n = 818) were in favor of related living donation and 31% (n = 299) were in favor of unrelated living donation. This attitude was associated with the following: country (Mexico 88%, Cuba 83%, Spain 81%) (p =0.016), female sex (p =0.026), having experience of donation and transplantation (p =0.001), having a favorable attitude to donation (P <0.001), considering the possibility of needing a transplant (P <0.001), being in favor of living kidney donation (P <0.001), being willing to accept a transplant from a living donor if necessary (P <0.001), discussing donation and transplantation with the family and partner (P <0.001), carrying out pro-social activities (P <0.001), believing that one's religion was in favor of donation and transplantation (P<0.001), and not worrying about bodily mutilation after donation (P <0.001).

CONCLUSIONS

Attitudes toward related LDLT among non-medical staff in various Spanish, Mexican and Cuban hospitals are favorable. In 86% of those surveyed, this attitude was not influenced by classical psychosocial factors.