Short- and Long-Term Outcomes After Live-Donor Transplantation with Hyper-Reduced Liver Grafts in Low-Weight Pediatric Recipients
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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.
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.
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.
LDLT can be undertaken in children with body weight < 10 kg achieving good results in high-volume centers by experienced surgeons.
KeywordsLiver failure PELD Mortality Graft failure Biliary leak
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.
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.
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.
Compliance with Ethical Standards
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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