Introduction: Pediatric liver transplantation (Tx) is a worldwide accepted therapy for those disorders that generate severe and irreversible acute and chronic liver diseases. We aim to report our 25-year experience, performing liver transplantation in children at a single center. Material and methods: Retrospective analysis of patients <18 years old who underwent primary Tx or re-transplant (reTx) of the liver between January 1995 and December 2021 at a single center. Demographic data, time on the waiting list, indication and type of Tx, length of hospital stay, ischemia times, complications, overall graft and patient survivals were analyzed. Survival analysis was also performed comparing 2 different groups, G1: 1995-2008 and G2: 2009-2022. Statistical analysis was performed with SPSS version 25.0. Results: A total of 243 Tx were done, 210 (86%) were primary Tx, 29 were re-Tx and 4 had a 3rd Tx, and 122 (50%) were female. The median age was 33 months (R=1-208), median weight was 13 kg (R=4-74 and z score weight for age -1.07 ± 1.5) and mean height of 100±35 cm (z score height for age -1,7 ± 1,8). Indications for Tx were: 88 (42%) biliary atresia, 33 (16%) cryptogenic acute liver failure, 24 (11%) fulminant viral hepatitis (HAV), 15 (7%) autoimmune hepatitis, 14 (7%) Alagille`s syndrome, 17% others. Re-Tx. were performed due to: chronic ductopenic rejection in 12 cases, arterial thrombosis in 7, primary graft dysfunction in 7, biliary complications in 4 and others in 3. The mean time on the waiting list for cadaveric Tx was 81 ± 191 days, mean post Tx hospitalization was 28±24 days (12±13 ICU and 15±19 general ward). One hundred fourteen (47%) Tx were performed with living donor; 129 (53%) with cadaveric grafts, of them 61(47%) with partial graft. The mean cold and warm ischemia time were 250±245 minutes and 44±42 minutes respectively: 402±127* and 45±17 minutes for cadaveric donors and 85±67* and 43±12 for living donors of cold and warm ischemia time (* p=0.001). The most frequent surgical complications were: 49 (20%) biliary (30 leaks and 19 strictures), 14(6%) hepatic artery thrombosis (11 early and 3 late), 10 (4%) portal vein (8 thrombosis and 2 stenosis), the remaining 10% were other complications (postoperative bleeding, acute ventral hernia, surgical wound infection, peritonitis); 14 (6%) cases of PTLD. Figure 1 shows patient and graft survival at 1, 5 and 10 years for those who received primary Tx and re-Tx. Figure 2 shows patient's survival divided in primary Tx and re-Tx. Conclusions: The most frequent cause of primary Tx is biliary atresia, while for re-Tx is chronic rejection. The most frequent early complication was bile leak, and the most frequent late complication was chronic rejection. Long-term survivals exceed the results from other regional and international centers.
Introduction: Closure of the abdominal wall after intestinal (ITx), combined liver-intestine (cL-ITx), multivisceral (MVT) or liver re-transplantation (L-reTx) usually can be a major challenge because those patients usually have a history of multiple abdominal surgeries, significant scarring and loss of abdominal domain. A variety of techniques, including anatomic closure (component separation) and use of surgical mesh or even abdominal wall transplantation have been described in order to overcome this challenge. We aim to report our experience using Non-vascularized Abdominal Rectus Fascia (NVARF) for abdominal wall closure. Patients and Methods: Retrospective report of a series of 24 recipients of NVARF after ITx, cL-ITx, MTV or L-reTx performed between January 2006 and December 2022 at a single transplant center. Results: 772 liver transplants (including 79 L-reTx), and 52 ITx, cL-ITx or MVT were performed in our center during the cited period. In 24 of them (3%) NVARF was used (12 in adult patients) 15 (62%) being on ITx graft recipients, 4 (17%) cL-ITx, 3 (13%) were MVT and 2 (8%) were L-reTx). Seventeen patients (71%) required re-operations: 11 (65%) before the 30th post-op day: 5 (45%) required 1 exploratory laparotomy, 2 (12%) underwent 2 re-operations, 2 (12%) patients had 3, 1 (6%) patient had 4 and 1 (6%) patient had 7. The most frequent indication for exploratory laparotomy were intra-abdominal collections (5, 45%) and abdominal hematoma (4, 36%). Eight patients required late re-operations (>30 days): 4 of them (57%) underwent total enterectomy due to graft rejection. Two patients had both early and late re-operations. During re-operations, NVARF was transected and no internal adhesions were found. After the surgical procedures, we closed the NVARF using running sutures. Only in 4 cases (17%) we had to remove the NVARF, and use a different abdominal wall closer technique: in 3 cases we replaced it for a synthetic mesh (2 of them due to a ventral hernia) and in 1 case, a second NVARF was used. At a mean follow up of 48 month, 20 patients still have the original NVARF (83%), without developing chronic ventral defects, nor developing adhesions to the non-vascularized graft. Conclusion:The use of a NVARF has become an efficient, economic reproducible alternative to overcame defects or compromised abdominal walls after complex liver or intestinal containing transplants. The NVARF can be re-sutured after being transected, it doesn't increase the risk of ventral defects, nor generates intra-abdominal adhesions. The potential risk for developing donor specific antibodies, remained to be studied in order to expand its use to non-transplant patients.
Despite mortality in pancreatic surgery has decreased over the last decade, morbidity remains high. One of the most important causes is pancreatic fistula. Recent studies have demonstrated the importance of fluid therapy management during the perioperative period in major abdominal surgeries. This finding was observed first in colonic surgery, demonstrating that overload of fluids increases postoperative complications. Objective. To evaluate the impact of fluid management on postoperative complications after laparoscopic distal pancreatectomy. Material and methods. Descriptive, retrospective study of a prospective database of patients whom underwent laparoscopic distal pancreatectomy from November 2011 to September 2018. Thirty patients were evaluated and divided in two groups depending on the fluid management (restrictive, or liberal). The data were collected from the anesthesia protocols and nursery reports (until 3rd postoperative day). Demographics, length of stay, kind of fluid management and complications were analyzed. For statistical analysis SPSS®v.21 was used (p < 0.05 was considered significant). Results. Out of 30 patients, 17% were male, mean age was 55 ± 18 years (r 19-82); 17 patients (57%) were included in the liberal group and 13 (43%) in the restrictive group. Twenty-three patients developed complications; 16 (53%) belonged to liberal group whereas 7 (23%) to restrictive group. (p = 0.01). Fourteen patients of liberal group vs. 6 patients of restrictive group had postoperative pancreatic fistula (p = 0.04). There were 7 patients (23%) in liberal group. and 4 (13%) patients in restrictive group with clinically relevant pancreatic fistula (13%, p = NS). Ninety day-mortality was 3.3, with no differences between groups. Conclusion. After laparoscopic distal pancreatectomy, liberal fluid administration at the perioperative period is associated with an increase in the incidence of complication, specially favoring the development of pancreatic fistula.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.