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Successful living donor liver transplantation plus domino-auxiliary partial orthotopic liver transplantation for pediatric patients with metabolic disorders

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Abstract

Purpose

To investigate the efficacy of living donor liver transplantation (LDLT) plus domino-auxiliary partial orthotopic liver transplantation (D-APOLT) in pediatric patients with metabolic disorders.

Methods

From May 2017 to October 2018, two patients with ornithine aminotransferase deficiency (OTCD) and one patient with type I Crigler-Najjar syndrome (CNS1) received LDLT, their livers were prepared as donors for D-APOLT. Two patients with CNS1 received domino liver grafts from OTCD patients; one OTCD patient received a domino liver graft from a CNS1 patient.

Results

The mean follow-up was 26.6 months. The liver function and ammonia remained in the normal range at the end of the follow-up in all recipients. One D-APOLT patient experienced portal vein thrombosis 2 days after transplantation and required reoperation, this patient presented an imbalance of portal blood perfusion between the native and the domino liver at 8 months after liver transplant. The imbalance was improved by interventional radiology treatment. Two LDLT patients experienced early mild acute rejection.

Conclusions

The non-cirrhotic livers from pediatric patients with metabolic liver disease can be used as domino donor grafts for selected pediatric patients with different metabolic liver disease. D-APOLT achieves ideal recipient outcomes and provides a strategy to expand donor source for children.

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Abbreviations

ALT:

Alanine transaminase

AST:

Aspartate transaminase

APOLT:

Auxiliary partial orthotopic liver transplantation

CNS1:

Crigler-Najjar syndrome

CT:

Computed tomography

D-APOLT:

Domino-auxiliary partial orthotopic liver transplantation

HV:

Hepatic vein

LDLT:

Living donor liver transplantation

LLS:

Left lateral segment

LT:

Liver transplantation

MHV:

Middle hepatic vein

MLD:

Metabolic liver diseases

MRCP:

Magnetic resonance cholangiopancreatography

NCMLD:

Non-cirrhotic metabolic liver diseases

OTCD:

Ornithine aminotransferase deficiency

PLT:

Partial liver transplantation

PV:

Portal vein

RL:

Right lobe

TB:

Total bilirubin

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Funding

This study was funded by Tianjin Clinical Research Center for Organ Transplantation Project (15ZXLCSY00070).

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Authors and Affiliations

  1. Organ Transplantation Center, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, 300192, Tianjin, China

    Chong Dong, Zhuolun Song, Xingchu Meng, Chao Sun, Kai Wang, Yang Yang, Hong Qin, Chao Han, Fubo Zhang, Weiping Zheng & Wei Gao

  2. Tianjin Key Laboratory for Organ Transplantation, Tianjin, China

    Chong Dong, Zhuolun Song, Xingchu Meng, Chao Sun, Kai Wang, Yang Yang, Hong Qin, Chao Han, Fubo Zhang, Weiping Zheng & Wei Gao

Authors
  1. Chong Dong
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  2. Zhuolun Song
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  3. Xingchu Meng
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  4. Chao Sun
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  5. Kai Wang
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  7. Hong Qin
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  10. Weiping Zheng
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  11. Wei Gao
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Corresponding author

Correspondence to Wei Gao.

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Conflict of interest statement

All the authors of this manuscript have no conflicts of interest to disclose.

Ethical approval

All the procedures in studies involving human participants were in accordance with the institutional review board of Tianjin First Center Hospital (approval number: 2018N148KY) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Dong, C., Song, Z., Meng, X. et al. Successful living donor liver transplantation plus domino-auxiliary partial orthotopic liver transplantation for pediatric patients with metabolic disorders. Pediatr Surg Int 36, 1443–1450 (2020). https://doi.org/10.1007/s00383-020-04756-3

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  • DOI: https://doi.org/10.1007/s00383-020-04756-3

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