Early vascular complications after pediatric liver transplantation

Sieders, Egbert; Peeters, Paul; TenVergert, Elisabeth M.; Jong, Koert P. de; Porte, Robert J.; Zwaveling, JH; Bijleveld, Cma; Slooff, Maarten J. H.

doi:10.1053/lv.2000.6146

Cited by 127 publications

(120 citation statements)

References 20 publications

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“…Sieders et al 19 reported low D/R age ratio as a risk factor for developing HAT in a series of 157 patients, but Oh et al 32 found no association of primary nonfunction or HAT in a series of 374 orthotopic liver transplantations (OLTs) in relation to donor age or D/R age ratio.…”

Section: Low D/r Age Ratiomentioning

confidence: 99%

“…40 This point mutation leads to ineffective inactivation of activated protein C. 26,27 Tanyel et al 41 reported a 10-yearold girl heterozygous for factor V Leiden mutation who 17,18 Low D/R age ratio 19 Prolonged surgical time 19 Intimal dissection 12 Bile leak 7,12 Liver from a non-heart-beating donor 12 Positive cytotoxic antibody cross-match 20 Poor baseline recipient hepatic arterial blood flow 21 Pediatric transplant recipient [4][5][6] Technique of graft preservation 22 Immunologic imbalance 23 Increased hematocrit 24 Coagulation abnormalities [25][26][27][28] Infections 1,29,30 Multiple rejection episodes 31 Chronic rejection 13 Tobacco use 31 Blood group type-incompatible grafts [14][15][16] experienced 3 episodes of HAT after an OLT. However, Hirshfield et al 42 showed that factor V Leiden mutation in the donor liver is not a major risk factor for hepatic vessel thrombosis and subsequent graft loss after OLT.…”

Section: Coagulation Abnormalitiesmentioning

confidence: 99%

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Hepatic artery thrombosis after orthotopic liver transplantation: A review of nonsurgical causes

et al. 2001

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Section: Low D/r Age Ratiomentioning

confidence: 99%

Section: Coagulation Abnormalitiesmentioning

confidence: 99%

Hepatic artery thrombosis after orthotopic liver transplantation: A review of nonsurgical causes

et al. 2001

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“…In pediatric liver transplant, the use of large-for-size grafts (GBWR > 4%) may cause graft damage such as vascular complications and necrosis due to insufficient blood supply to the graft. 13,14 Reduction of the graft has been used in several centers. However, it has some disadvantages for both the donor (in case of in situ reduction) and the recipient.…”

Section: Discussionmentioning

confidence: 99%

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Yıldırım³

et al. 2017

Exp Clin Transplant

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“…[3][4][5] In pediatric liver transplant, the use of an LFSG (GBWR > 4%) may cause graft damage such as vascular complications and necrosis due to an insufficient blood supply to the graft. 6,7 The main problem with an LFSG may include the risk of abdominal compartment syndrome due to the small size of the recipient abdominal cavity, size discrepancies in vascular caliber, insufficient portal circulation, and disturbance of tissue oxygenation. 8 Some liver transplant centers reduce the graft into a monosegmental or hyperreduced graft.…”

Section: Discussionmentioning

confidence: 99%

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2015

Exp Clin Transplant

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Objectives: The ideal ratio between liver transplant graft mass and recipient body weight is unknown, but the graft probably must weigh 0.8% to 2.0% recipient weight. When this ratio > 4%, there may be problems due to large-for-size transplant, especially in recipients < 10 kg. This condition is caused by discrepancy between the small abdominal cavity and large graft and is characterized by decreased blood supply to the liver graft and graft dysfunction. We evaluated our experience with large-for-size grafts. Materials and Methods: We retrospectively evaluated 377 orthotopic liver transplants that were performed from 2001-2014 in our center. We included 188 pediatric transplants in our study. Results: There were 58 patients < 10 kg who had living-donor living transplant with graft-to-bodyweight ratio > 4%. In 2 patients, the abdomen was closed with a Bogota bag. In 5 patients, reoperation was performed due to vascular problems and abdominal hypertension, and the abdomen was closed with a Bogota bag. All Bogota bags were closed in 2 weeks. After closing the fascia, 10 patients had vascular problems that were diagnosed in the operating room by Doppler ultrasonography, and only the skin was closed without fascia closure. No graft loss occurred due to large-for-size transplant. There were 8 patients who died early after transplant (sepsis, 6 patients; brain death, 2 patients). There was no major donor morbidity or donor mortality. Conclusions: Large-for-size graft may cause abdominal compartment syndrome due to the small size of the recipient abdominal cavity, size discrepancies in vascular caliber, insufficient portal circulation, and disturbance of tissue oxygenation. Abdominal closure with a Bogota bag in these patients is safe and effective to avoid abdominal compartment syndrome. Early diagnosis by ultrasonography in the operating room after fascia closure and repeated ultrasonography at the clinic may help avoid graft loss.

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Early vascular complications after pediatric liver transplantation

Cited by 127 publications

References 20 publications

Hepatic artery thrombosis after orthotopic liver transplantation: A review of nonsurgical causes

Hepatic artery thrombosis after orthotopic liver transplantation: A review of nonsurgical causes

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