Development of liver size and perfusion after reduced‐size liver transplantation in children

Abstract

The technique of segmental liver transplantation (s-LTx) provides a method to overcome the shortage of suitable livers for small recipients. Patient survival rates are parallel to those obtained with whole liver transplantation (w-LTx). For long-term rehabilitation, adaptive liver growth and adequate perfusion is crucial; however, morphometric and hemodynamic parameters in growing children with s-LTx are not available. Seventeen children who received a s-LTx and 25 with a w-LTx who had follow-up evaluation 1 and 2 yr after LTx were studied. Mean age at time of transplantation was 4.3 +/- 3.5 yr for s-LTx and 10.3 +/- 6.0 yr for w-LTx, mean height 98 +/- 21 cm and 122 +/- 30 cm respectively. At follow-up evaluation mean values for liver enzymes, bilirubin and prothrombin time were in the normal ranges for both groups. Liver dimensions were measured by gray scale ultrasound, and hemodynamic parameters by Doppler sonography in the portal vein and hepatic artery using an Acuson 128 machine. Maximal (Vmax), minimal (Vmin) and time-average velocity (TAV) were measured and the resistive index (RI) calculated. We found that 1 and 2 yr after LTx liver dimensions were at a mean in the upper normal range of healthy controls. Spleen size was above the normal range and did not show any tendency towards regression. Mean Vmax in the hepatic artery in s-LTx and w-LTx was 48 cm/sec vs. 28 cm/sec after 1 yr and 30 cm/sec vs. 35 cm/sec after 2 yr, the RI 0.66 vs. 0.55 and 0.59 vs. 0.73, respectively (p for all parameters > 0.05). Maximal portal vein flow was 25 cm/sec in s-LTx vs. 29 cm/sec in w-LTx. Blood flow calculated by vessel diameter and TAV showed no statistical difference between both groups. In conclusion, liver size after s-LTx and w-LTx was increased to the upper normal range, and portal vein blood flow velocities were within the normal range. Vmax in the hepatic artery was reduced in s-LTx; however, the reduction was to the same extent as in w-LTx. In the view of long-term functional adaptation, s-LTx is not inferior to w-LTx.

Adaptation of split liver grafts in pediatric patients

“…The present manuscript by Hoyer et al. (10) makes interesting observations and allows for speculation regarding the importance of such flow characteristics, particularly at the time of transplant when invariably portal vein and hepatic arterial flow are abnormal because of liver disease and there may be discrepancies in recipient and donor.…”

“…Consequently, the utilization of donor‐to‐recipient weight ratio (DRWR) is utilized to reflect such a relationship and its estimated safe limit has been observed to be 0.5 (12). The long‐term size observations reported in this series (10) provide interesting data on the growth of reduced liver grafts in children, but, furthermore, allow for speculation regarding the use of such grafts in the adult population. This is evidenced by the development of innovative techniques of auxilliary partial orthotopic liver transplantation, and right lobe/left lobe split liver transplantation.…”

“…The article entitled Development of liver size and perfusion after reduced‐sized liver transplantation in children , published in the current issue of Pediatric Transplantation , addresses the pivotal concerns of segmental transplantation: graft size in relation to recipient, and vascular patency and flow (10). The significance of this contribution can be better appreciated by the immediate implications of such relationships at the time of transplant.…”

Renal Biopsy: Use of Biomarkers as a Tool for the Diagnosis of Focal Segmental Glomerulosclerosis

“…These clinical manifestations have shed some light on the hypothesis that a possible circulating factor would be involved in FSGS [4]. The concept of FSGS permeability factor is highly supported by recurrent syndrome after transplantation [5], proteinuria response to the plasmapheresis therapy [6], immunoadsorption [7], and transient nephrotic syndrome in a newborn whose mother had the disease [8]. …”