Delayed sequential abdominal wall closure in pediatric liver transplantation to overcome “large for size” scenarios

Molino, Jose Andrés; Hidalgo, Ernest; Quintero, Jesús; Muñoz, Ana; Ortega, Juan José López; Juampérez, Javier; Mercadal-Hally, María; Riera, Lluı́s; Riaza, Lucía; Bilbao, Itxarone; Dopazo, Cristina; Caralt, M.; Pando, Elizabeth; Gómez‐Gavara, Concepción; Charco, Ramón

doi:10.1111/petr.14132

Cited by 6 publications

(8 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a cohort of 1078 pediatric LDLT, 6 322 patients had a BW ≤7 kg, 6.1% of the infants received RLLS/HRLLS, and 10.8% underwent delayed abdominal closure. Even though the patient and graft survival rates were similar (BW ≤7 kg vs BW >7 kg), ICU and hospital stay were significantly higher in the small recipients, similar to the findings of Molino et al 18 in a recent publication addressing delayed sequential abdominal closure. Additionally, current studies in patients with delayed closure in our series showed 31% (18/58) of positive blood cultures during the postoperative period (unpublished data).…”

Section: Discussionsupporting

confidence: 86%

Anterior hepatic resection: A simple and safe technique for reducing the antero‐posterior diameter of the liver graft for small pediatric recipients

Neto

Costa

Pereira

et al. 2023

Pediatric Transplantation

View full text Add to dashboard Cite

Background:The techniques involved in neonatal and infantile transplantation require approaches that can sculpt a left lateral segment (LLS) to the right shape and size and avoid large-for-size syndrome. The aim of this article is to describe the anterior hepatic resection (AHR) of the LLS in pediatric LDLT. Methods:A retrospective anatomical study of preoperative image studies, description of the technique for AHR, and short-term results. Results:The AHR was performed in eight cases. All donors were male, with average age, BW, and BMI of 28.3 ± 5.9 years, 74.2 ± 9.3 kg, and 24.3 ± 2.6 kg/m2, respectively. Donors were discharged at an average of 3.6 ± 0.8 days. The median recipient age and BW at transplantation were 6.9 (2.7 to 11) months and 5.9 (3.9 to 8) kg, respectively, and the recipient-to-donor body weight ratio (RDBW) was <0.1 in all but one case.The mean percentage reduction in graft weight and in the antero-posterior diameter were 33.2% ± 5.5% and 38.3% ± 12.6%, respectively. The average (SD) GRWR was 4.8% ± 1.7% before all the resections and 3.5% ± 1.0% after the procedures. Seven patients were primarily closed. Conclusion:After LLS resection, a nonanatomical anterior resection of the LLS was accomplished without hilar vascular dissection to segments II/III. The final liver graft allowed primary abdominal wall closure in all but one patient, with meaningful adjustments in GRWR. AHR proved to be simple, safe, reproducible, and effective in the presented case series.

show abstract

Section: Discussionsupporting

confidence: 86%

Anterior hepatic resection: A simple and safe technique for reducing the antero‐posterior diameter of the liver graft for small pediatric recipients

Neto

Costa

Pereira

et al. 2023

Pediatric Transplantation

View full text Add to dashboard Cite

show abstract

“…Four patients were diagnosed with intestinal perforation (3.9%) after PLT (Table 1), three patients with BA and one with neonatal hemochromatosis (HC). None of the patients with IP was older than 12 months (6 ± 4.5 [1][2][3][4][5][6][7][8][9][10][11]) at the moment of the liver transplant. The mean weight of those transplanted with IP was 6.3 ± 2.5 kg vs 19.9 ±15.4 (p< 0.05).…”

Section: Resultsmentioning

confidence: 99%

“…Patients with BA presented moderate abdominal distension, infection signs with inflammatory parameters in laboratory tests and CT scan showing signs of perforation. Patient with neonatal hemochromatosis was the only one who had a temporary abdominal closure with transparent mesh (4) , diagnosis was made by direct vision of the perforations. Despite the fact that all the patients had abdominal drainage, collecting the area of the biliary-enteric anastomosis and posterior to the liver cut surface, in no case was it useful for the diagnosis of intestinal perforation.…”

Section: Resultsmentioning

confidence: 99%

Intestinal perforation after pediatric liver transplantation: risk factors and management

Barila¹,

Molino²,

Hidalgo³

et al. 2023

Cir Pediatr

View full text Add to dashboard Cite

Background. Intestinal perforation (IP) after pediatric liver transplant (PLT) is an uncommon complication with high mortality reported. The aim of this study is to identify the risk factors and management of this complication.Material and methods. Retrospective study of IP after PLT from January 2014 to October 2020.Results. Four intestinal perforations were indentificated in 102 PLT (3,9%). Three patients with BA and one neonate with hemochromatosis (HC) presented this complication. The mean weight of patients with IP was 6.3± 2.5kg (3.1-9) and 19.9 ± 15.4kg for the rest (p< 0,05). All IP with BA had a previous laparotomy. Two living donors and two left lateral reduced liver were implanted. The diagnosis of intestinal perforation was done on day 11 ± 3.3 (8-15 days). Diagnosis was suspected with clinical and biological signs of perforation, CT scan confirmed the diagnosis in patiens with BA and by direct visualization through the mesh for temporary closure in the patient with hemocromatosis. Urgent laparotomy was performed. We identified three colonic perforations, all of them in BA patients and all repaired with direct suture. The patient with HC presented multiple perforations secondary to necrotizing enterocolitis requiring an ileostomy and finally died due to multiorgan failure. Conclusion.Intestinal perforation after PLT is an infrequent complication. Age, weight, previous laparotomy and BA could be risk factors for IP in PLT. Urgent laparotomy after diagnosis should be performed in order to reduce mortality. Isolated IP with adequate treatment might not affect long term outcomes after pediatric liver transplantation.

show abstract

“…Cuatro pacientes (3,9%) fueron diagnosticados de perforación intestinal tras el THP (Tabla I), tres con AB y uno con hemocromatosis (HC) neonatal. Ninguno de los pacientes con PI tenía más de 12 meses (6 ± 4,5 [1][2][3][4][5][6][7][8][9][10][11]) en el momento de la realización del trasplante hepático. El peso medio de los pacientes trasplantados con PI era de 6,3 ± 2,5 kg frente a 19,9 ± 15,4 kg (p< 0,05).…”

Section: Resultsunclassified

“…Los pacientes con AB presentaban distensión abdominal moderada, signos de infección con parámetros inflamatorios en los análisis de laboratorio, y escáner con signos de perforación. El paciente con hemocromatosis neonatal era el único que presentaba cierre abdominal temporal con malla transparente (4) ; en su caso, el diagnóstico se efectuó mediante visión directa de las perforaciones. A pesar de que todos los pacientes tenían un drenaje abdominal que recogía la zona de la anastomosis bilioentérica y posterior a la superficie de corte del hígado, en ninguno de los casos resultó útil para el diagnóstico de perforación intestinal.…”

Section: Resultsunclassified

Perforación intestinal tras trasplante hepático pediátrico: factores de riesgo y manejo

Barila¹,

Molino²,

Hidalgo³

et al. 2023

Cir Pediatr

View full text Add to dashboard Cite

ResumenIntroducción. La perforación intestinal (PI) tras trasplante hepático pediátrico (THP) es una complicación poco frecuente, pero con una elevada mortalidad. El objetivo de este estudio es identificar los factores de riesgo y el manejo de esta complicación.Material y métodos. Estudio retrospectivo de la PI tras THP entre enero de 2014 y octubre de 2020.Resultados. Se hallaron 4 perforaciones intestinales en 102 THP (3,9%). Presentaron esta complicación 3 pacientes con atresia biliar (AB) y un neonato con hemocromatosis (HC). El peso medio de los pacientes con PI era de 6,3 ± 2,5 kg (3.1-9) y de 19,9 ± 15,4 kg en el caso del resto (p<0,05). Todos los pacientes con PI y AB habían sido sometidos previamente a laparotomía. Se implantaron 2 hígados de donantes vivos y 2 hígados laterales reducidos izquierdos. El diagnóstico de perforación intestinal se efectúo en el día 11 ± 3,3 (8-15 días), sospechándose con signos clínicos y biológicos de perforación, y confirmándose mediante escáner en los pacientes con AB y mediante visualización directa a través de la malla para el cierre temporal en el paciente con hemocromatosis. Se llevó a cabo laparotomía de urgencia. Se identificaron 3 perforaciones de colon, todas ellas en pacientes con AB y reparadas con sutura directa. El paciente con HC presentaba múltiples perforaciones secundarias a enterocolitis necrotizante que precisaron ileostomía, falleciendo finalmente como consecuencia de un fallo multiorgánico.Conclusión. La perforación intestinal tras THP es una complicación poco frecuente. La edad, el peso, las laparotomías previas y la AB podrían ser factores de riesgo de PI en el THP. Para reducir la mortalidad, es conveniente practicar una laparotomía de urgencia tras el diagnóstico. Una PI aislada con un adecuado tratamiento puede no influir en los resultados a largo plazo tras un trasplante hepático pediátrico.

show abstract

Delayed sequential abdominal wall closure in pediatric liver transplantation to overcome “large for size” scenarios

Cited by 6 publications

References 25 publications

Anterior hepatic resection: A simple and safe technique for reducing the antero‐posterior diameter of the liver graft for small pediatric recipients

Anterior hepatic resection: A simple and safe technique for reducing the antero‐posterior diameter of the liver graft for small pediatric recipients

Intestinal perforation after pediatric liver transplantation: risk factors and management

Perforación intestinal tras trasplante hepático pediátrico: factores de riesgo y manejo

Contact Info

Product

Resources

About