Elsevier

Transplantation Proceedings

Volume 43, Issue 1, January–February 2011, Pages 161-164
Transplantation Proceedings

Liver transplantation
Outcome
Living Related Donor Liver Transplantation in Children

https://doi.org/10.1016/j.transproceed.2010.11.013Get rights and content

Abstract

Objective

The objective of this study was to report our experience with pediatric orthotopic liver transplantation (OLT) with living related donors.

Methods

We performed a retrospective chart analysis of 121 living related donor liver transplantations (LRDLT) from June 1998 to June 2010.

Results

Indications were biliary atresia (BA; n = 81), primary sclerosing cholangitis (n = 5), α-1 antitrypsin deficiency (n = 4); cholestasis (n = 9), fulminant hepatic failure (n = 8), autoimmune hepatitis (n = 2), Alagille syndrome (n = 4), hepatoblastoma (n = 3), tyrosinemia (n = 2), and congenital hepatic fibrosis (n = 3). The age of the recipients ranged from 7–174 months (median, 22) and the weights ranged from 6–58 kg (median, 10). Forty-nine children (40.5%) weighed ≤10 kg. The grafts included the left lateral segment (n = 108), the left lobe (n = 12), and the right lobe (n = 1). The donors included 71 mothers, 45 fathers, 2 uncles, 1 grandmother, 1 grandfather, and 1 sister with a median age of 29 years (range, 16–53 ys) and a median weight of 68 kg (range, 47–106). Sixteen patients (12.9%) required retransplantation, most commonly due to hepatic artery thrombosis (HAT; n = 13; 10.7%). The other complications were biliary stenosis (n = 25; 20.6%), portal vein thrombosis (PVT; n = 11; 9.1%), portal vein stenosis (n = 5; 4.1%), hepatic vein stenosis (n = 6; 4.9%), and lymphoproliferative disorders (n = 8; 6.6%). The ultimate survival rate of recipients was 90.3% after 1 year and 75.8% after 3 years. Causes of early death within 1 month were HAT (n = 6), PVT (n = 2), severe graft dysfunction (n = 1), sepsis (n = 1), and intraoperative death in children with acute liver failure (n = 2). Causes of late deaths included lymphoproliferative disease (n = 3), chronic rejection (n = 2), biliary complications (n = 3), and recurrent disease (n = 3; hepatoblastoma and primary sclerosing cholangitis).

Conclusions

Despite the heightened possibility of complications (mainly vascular), LRDLT represented a good alternative to transplantation from cadaveric donors in pediatric populations. It was associated with a high survival ratio.

Section snippets

Methods

We performed a chart analysis of 121 LRDLT performed at our institution between June 1998 and June 2010. All patients were identified by retrospective review of a prospectively acquired liver database that contained recipient and donor demographics, perioperative findings, and postoperative outcomes.

Donors

The donors included 71 mothers, 45 fathers, 2 uncles, 1 grandmother, 1 grandfather, and 1 sister with a median age of 29 years (range, 16–53) and a median weight of 68 kg (range, 47–106).

The liver grafts consisted of the left lateral segment with the left hepatic vein in 108 cases or an extended left lateral segment, which always included the left and middle hepatic veins, in 12 donors. One case used the right hepatic lobe. The median duration of the donor surgeries was 6.8 hours (range, 4.3–11

Discussion

LRDLT has become a good option to provide suitable grafts for children with liver diseases, mainly in developing countries, where cadaveric donation systems are still limited.2 Even in the pediatric/model of end-stage liver disease (PELD/MELD) era, when children and more severely ill patients are favored, LRDLT maintains its indisputable role. LRDLT is sometimes the only option available to save children with end-stage hepatic diseases, liver tumors, or fulminant hepatic failure.3

Because most

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