Abstract
Objective
To evaluate short- and long-term outcomes after live-donor liver transplantation (LT) with hyper-reduced grafts in low-weight pediatric recipients.
Summary Background Data
LT is an established curative therapy for children with end-stage chronic liver disease or acute liver failure. A major problem in pediatric LT has been the lack of size-matched donor organs. The disadvantage of the use of large-for-size grafts is the insufficient tissue oxygenation and graft compression, which result in poor outcomes. The shortage of suitable donors is most notable in children under 10 kg. To overcome such obstacle, in situ hyper-reduced live-donor liver grafts have been introduced. Available articles in the literature are based on small samples and are deficient in long-term follow-up.
Methods
A single-cohort, retrospective analysis was conducted including 59 pediatric patients under 10 kg who underwent hyper-reduced (in situ “a la carte” left lateral segment reduction) live-donor LT (LDLT) between February 1994 and February 2018.
Results
The most frequent cause of liver failure was biliary atresia (70%). Median recipient weight was 8 kg. Vascular complications were confirmed in 15% of the sample, while 45% presented biliary complications. Median follow-up time was 40.3 months. Ten-year overall survival rate was 74%. Pediatric end-stage liver disease score > 23 was associated with a higher risk of post-operative complications.
Conclusion
LDLT can be undertaken in children with body weight < 10 kg achieving good results in high-volume centers by experienced surgeons.
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References
Perito ER, Roll G, Dodge JL, et al. Split liver transplantation and pediatric waitlist mortality in the United States: potential for improvement. Transplantation. . Epub ahead of print April 21, 2018. https://doi.org/10.1097/TP.0000000000002249.
Akdur A, Kirnap M, Ozcay F, et al. Large-for-size liver transplant: a single-center experience. Exp Clin Transplant. 2015;13 Suppl 1:108–110.
Kim WR, Lake JR, Smith JM, et al. OPTN/SRTR 2015 Annual Data Report: Liver. Am J Transplant. 2017;17 Suppl 1:174–251.
de Santibañes E, McCormack L, Mattera J, et al. Partial left lateral segment transplant from a living donor. Liver Transpl. 2000;6:108–112.
Ardiles V, Ciardullo MA, D’Agostino D, et al. Transplantation with hyper-reduced liver grafts in children under 10 kg of weight. Langenbecks Arch Surg. 2013;398:79–85.
Kanazawa H, Sakamoto S, Fukuda A, et al. Living-donor liver transplantation with hyperreduced left lateral segment grafts: a single-center experience. Transplantation. 2013;95:750–754.
Ciardullo M, Andreani O, Mattera J, et al. Reducción Hepática en el Trasplante Ortotopico de Higado. Nuestra Experiencia. Revista Argentina de Cirugía. Retrieved January 10, 2019, from: http://www.eduardodesantibanes.com/files/articulos/Reduccion%20hepatica%201990.pdf. 1990.
PELD Calculator - OPTN. Retrieved December 12, 2018 from: https://optn.transplant.hrsa.gov/resources/allocation-calculators/peld-calculator/.
Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–196.
Porrett PM, Hsu J, Shaked A. Late surgical complications following liver transplantation. Liver Transpl. 2009;15:S12–S18.
Cauley RP, Vakili K, Potanos K, et al. Deceased donor liver transplantation in infants and small children: are partial grafts riskier than whole organs? Liver Transpl. 2013;19:721–729.
Kitajima T, Sakamoto S, Sasaki K, et al. Impact of graft thickness reduction of left lateral segment on outcomes following pediatric living donor liver transplantation. Am J Transplant. . Epub ahead of print April 19, 2018. https://doi.org/10.1111/ajt.14875.
Thomas N, Thomas G, Verran D, et al. Liver transplantation in children with hyper-reduced grafts - a single-center experience. Pediatr Transplant. 2010;14:426–430.
McDiarmid SV, Anand R, Martz K, et al. A multivariate analysis of pre-, peri-, and post-transplant factors affecting outcome after pediatric liver transplantation. Ann Surg. 2011;254:145–154.
Desai CS, Sharma S, Gruessner A, et al. Effect of small donor weight and donor-recipient weight ratio on the outcome of liver transplantation in children. Pediatr Transplant. 2015;19:366–370.
Bismuth H, Houssin D. Reduced-sized orthotopic liver graft in hepatic transplantation in children. Surgery. 1984;95:367–370.
Houssin D, Soubrane O, Boillot O, et al. Orthotopic liver transplantation with a reduced-size graft: an ideal compromise in pediatrics? Surgery. 1992;111:532–542.
Shehata MR, Yagi S, Okamura Y, et al. Pediatric Liver Transplantation Using Reduced and Hyper-Reduced Left Lateral Segment Grafts: A 10-Year Single-Center Experience. Am J Transplant. 2012;12:3406–3413.
Kasahara M, Fukuda A, Yokoyama S, et al. Living donor liver transplantation with hyperreduced left lateral segments. J Pediatr Surg. 2008;43:1575–1578.
Arnon R, Annunziato R, Miloh T, et al. Liver transplantation in children weighing 5 kg or less: Analysis of the UNOS database. Pediatr Transplant. 2011;no–no.
Chung PHY, Chan SC, Mok VWK, et al. Recipient body size does not matter in pediatric liver transplantation. J Pediatr Surg. 2014;49:1734–1737.
Hsu EK, Shaffer ML, Gao L, et al. Analysis of Liver Offers to Pediatric Candidates on the Transplant Wait List. Gastroenterology. 2017;153:988–995.
Linecker M, Krones T, Berg T, et al. Potentially inappropriate liver transplantation in the era of the “sickest first” policy - A search for the upper limits. J Hepatol. . Epub ahead of print November 11, 2017. https://doi.org/10.1016/j.jhep.2017.11.008.
Venick RS, Farmer DG, Soto JR, et al. One Thousand Pediatric Liver Transplants During Thirty Years: Lessons Learned. J Am Coll Surg. 2018;226:355–366.
Oh SH, Kim KM, Kim DY, et al. Long-term outcomes of pediatric living donor liver transplantation at a single institution. Pediatr Transplant. 2010;14:870–878.
Bourdeaux C, Tri TT, Gras J, et al. PELD score and posttransplant outcome in pediatric liver transplantation: a retrospective study of 100 recipients. Transplantation. 2005;79:1273–1276.
Barshes NR, Lee TC, Udell IW, et al. The pediatric end-stage liver disease (PELD) model as a predictor of survival benefit and posttransplant survival in pediatric liver transplant recipients. Liver Transpl. 2006;12:475–480.
Shneider BL, Neimark E, Frankenberg T, et al. Critical analysis of the pediatric end-stage liver disease scoring system: a single center experience. Liver Transpl. 2005;11:788–795.
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Category 1:
Conception and design of study: MDS, MR, and MEC.
Acquisition of data: MDS, MR, MEC, VA, and GB.
Analysis and/or interpretation of data: MDS, MR, MEC, DD, JMDP, JP, JM, CB, MC, and EDS.
Category 2:
Drafting the manuscript: MDS, MR, and MEC.
Revising the manuscript critically for important intellectual content: MDS, MR, MEC, VA, GB, DD, JMDP, JP, JM, CB, MC, and EDS.
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Approval of the version of the manuscript to be published (the names of all authors must be listed): MDS, MR, MEC, VA, GB, DD, JMDP, JP, JM, CB, MC, and EDS.
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Informed consent was obtained from all patients before surgery and the Hospital Italiano Ethics Committee gave ethical approval to perform this study (Protocol No. 3699). The study protocol has been registered on ClinicalTrials.gov database (identifier NCT03594864).
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Raices, M., Czerwonko, M.E., Ardiles, V. et al. Short- and Long-Term Outcomes After Live-Donor Transplantation with Hyper-Reduced Liver Grafts in Low-Weight Pediatric Recipients. J Gastrointest Surg 23, 2411–2420 (2019). https://doi.org/10.1007/s11605-019-04188-y
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DOI: https://doi.org/10.1007/s11605-019-04188-y