European Liver Transplant Registry: Donor and transplant surgery aspects of 16,641 liver transplantations in children

Goyet, Jean de Ville de; Baumann, Ulrich; Karam, Vincent; Adam, René; Nadalin, Silvio; Heaton, Nigel; Reding, Raymond; Branchereau, Sophie; Mirza, Darius F.; Klempnauer, Jürgen; Fischer, Lutz; Kaliciński, Piotr; Colledan, M.; Santamarı́a, Manuel; Kleine, Ruben H de; Chardot, Christophe; Yılmaz, Sezai; Kılıç, Murat; Boillot, Olivier; Francesco, Fabrizio di; Polak, Wojciech; Verkade, Henkjan J.

doi:10.1002/hep.32223

Cited by 54 publications

(63 citation statements)

References 22 publications

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“…Indeed, in a recent European registry study, up to 10% of all SLT had a static cold storage time >12 h. This was associated with a significant reduction in graft and recipient survival. [1,6] Consequently, improving graft preservation for ex situ split grafts is a key challenge. By adding oxygen to an active perfusion at cold temperatures, a short period of end-ischemic HOPE uploads cellular energy levels and protects the liver graft's mitochondrial metabolism.…”

Section: Discussionmentioning

confidence: 99%

“…[3] As a result of technical aspects inherent to the ex situ split, these partial grafts have prolonged static cold storage time, which negatively impacts graft survival despite the use of optimal donors. [1,[4][5][6] A recently validated strategy to optimize preservation of marginal whole-liver grafts is the use of end-ischemic hypothermic oxygenated perfusion (HOPE). [7][8][9] This ex situ machine perfusion strategy has been shown to mitigate ischemia/reperfusion injury (IRI) of liver grafts by reducing static cold storage and uploading cellular energy levels with a positive impact on posttransplantation outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Liver transplantation of partial grafts after ex situ splitting during hypothermic oxygenated perfusion—The HOPE–Split pilot study

Rossignol

Muller

Hervieu

et al. 2022

Liver Transplantation

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Partial liver grafts from ex situ splitting are considered marginal due to prolonged static cold storage. The use of ex situ hypothermic oxygenated perfusion (HOPE) may offer a strategy to improve preservation of ex situ split grafts. In this single‐center pilot study, we prospectively performed ex situ liver splitting during HOPE (HOPE–Split) for adult and pediatric partial grafts over a 1‐year period (November 1, 2020 to December 1, 2021). The primary safety endpoint was based on the number of liver graft–related adverse events (LGRAEs) per recipient, including primary nonfunction, biliary complications, hepatic vascular complications, and early relaparotomies and was compared with consecutive single‐center standard ex situ split transplantations (Static–Split) performed from 2018 to 2020. Secondary endpoints included preservation characteristics and early outcomes. Sixteen consecutive HOPE–Split liver transplantations (8 HOPE–Split procedures) were included and compared with 24 Static–Splits. All HOPE–Split grafts were successfully transplanted, and no graft loss nor recipient death was encountered during the median follow‐up of 7.5 months (interquartile range, 5.5–12.5). Mean LGRAE per recipient was similar in both groups (0.31 ± 0.60 vs. 0.46 ± 0.83; p = 0.78) and split duration was not significantly increased for HOPE–Split (216 vs. 180 min; p = 0.45). HOPE–Split grafts underwent perfusion for a median of 125 min, which significantly shortened static cold storage (472 vs. 544 min; p = 0.001), whereas it prolonged total ex vivo preservation (595 vs. 544 min; p = 0.007) and reduced neutrophil infiltration on reperfusion biopsies (p = 0.04) compared with Static–Split. This clinical pilot study presents first feasibility and safety data for transplantation of partial liver grafts undergoing ex situ split during HOPE and suggests improved preservation compared with static ex situ splitting. These preliminary results will allow to set up large‐scale trials on the use of machine perfusion in pediatric and split‐liver transplantation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Liver transplantation of partial grafts after ex situ splitting during hypothermic oxygenated perfusion—The HOPE–Split pilot study

Rossignol

Muller

Hervieu

et al. 2022

Liver Transplantation

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“…Our analysis demonstrated that the number of FSLG PLT from pediatric donors had strongly decreased already before the year 2000 and that the number of SG PLT steadily decreased in the last decade. [ 1 ] Similar observations were made on LT in adult patients, with domino LT and living donor LT also declining in the last decade while the use of NHBD has increased rapidly—one third of donors in 2016 [ 4 ] and growing nowadays. In children, 86 NHBD had ever been used in ELTR before 2018—a 0.5% figure of all donors; of these grafts, 58 were FSLG and only 28 were SG.…”

mentioning

confidence: 67%

“…The recent ELTR report [ 1 ] was dedicated to pediatric LT (PLT) performed from 1968 until 2017, a period with no machine perfusion use. The very first reports of PLT after machine perfusion dated back only to 2018 for full‐size liver graft (FSLG) [ 2 ] and to 2020 for left and right split grafts (SG), respectively.…”

mentioning

confidence: 99%

Letter to the editor: Organ shortage and pediatric liver transplantation: David against Goliath…

et al. 2022

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“…Pediatric liver transplantation (PLTx) has made crucial improvements since the first surgical interventions by Dr. Starzl in the late ’60 in Pittsburgh 1 , 2 , and now represents a relevant part of the annual liver transplant rate worldwide: in 2020, 5.2% of liver transplantations performed in Italy involved the pediatric population (0 to 17-year-old patients) and similar percentages are reported in Europe and North America 3 , 4 .…”

Section: Introductionmentioning

confidence: 96%

Not only a small liver - The pathologist’s perspective in the pediatric liver transplant setting

et al. 2022

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Summary Pediatric liver transplantation represents a safe and long-lasting treatment option for various disease types, requiring the pathologist’s input. Indeed, an accurate and timely diagnosis is crucial in reporting and grading native liver diseases, evaluating donor liver eligibility and identifying signs of organ injury in the post-transplant follow-up. However, as the procedure is more frequently and widely performed, deceptive and unexplored histopathologic features have emerged with relevant consequences on patient management, particularly when dealing with long-term treatment and weaning of immunosuppression. In this complex and challenging scenario, this review aims to depict the most relevant histopathologic conditions which could be encountered in pediatric liver transplantation. We will tackle the conditions representing the main indications for transplantation in childhood as well as the complications burdening the post-transplant phases, either immunologically ( i.e. , rejection) or non-immunologically mediated. Lastly, we hope to provide concise, yet significant, suggestions related to innovative pathology techniques in pediatric liver transplantation.

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European Liver Transplant Registry: Donor and transplant surgery aspects of 16,641 liver transplantations in children

Abstract: Background and Aims:The European Liver Transplant Registry (ELTR) has collected data on liver transplant procedures performed in Europe since 1968.

Cited by 54 publications

References 22 publications

Liver transplantation of partial grafts after ex situ splitting during hypothermic oxygenated perfusion—The HOPE–Split pilot study

Liver transplantation of partial grafts after ex situ splitting during hypothermic oxygenated perfusion—The HOPE–Split pilot study

Letter to the editor: Organ shortage and pediatric liver transplantation: David against Goliath…

Not only a small liver - The pathologist’s perspective in the pediatric liver transplant setting

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