Impact of Graft Type on Outcome in Pediatric Liver Transplantation

Diamond, Ivan; Fecteau, Annie; Millis, J. Michael; Losanoff, Julian E.; Anand, Ravinder; Song, Changhong; Dunn, Stephen P.; Menéndez, J. Carlos; Flynn, Louise; Jonas, Maureen M.; Krawczuk, Laura E.; Christoff, M.; Kane, Robert E.; Phillips, E.; Ferrer, L.; Heffron, Thomas G.; DePaolo, J M; Pillen, Todd; Davis, Lori; Bucuvalas, John C.; Ryckman, Frederick C.; Hawkins, Andre; Arya, Gajra; Narkewicz, Michael R.; Sokol, Ronald J.; Karrer, Frederick M.; Mark, Ching-Tong; Orban-Eller, Kathy; Rand, Elizabeth B.; Anderer, K.; Mazariegos, George; Chien, Nydia; Seward, Lynn; Atkinson, Prescott; Telega, Grzegorz; Lerrett, S.; Roden, Jay S.; Mittal, Naveen; Cutright, L.; Alonso, Estella M.; Lokar, Joan; Kelly, Sue; Neighbors, Katie; Andrews, Walter S.; Daniel, J.; Fioravanti, V.; Tendick, A.; Desai, Dev M.; Jarvis, Sheba; Ng, Vicky L.; Angelis, Maria De; Benidir, Andréanne; Tector, Joseph; Lim, Joel D.; Molleston, Jean P.; Pearson, Jennifer M.; Schwarz, Kathleen B.; Colombani, Paul M.; Alford, Mary Kay; Felix, M.; Jurao, Robert; Eason, James D.; Eshun, John; Powell, Sandra L.; Freese, Deborah K.; Weckwerth, Jody; Greseth, Jean; Young, Louis L.; Fisher, Robert A.; Akyeampong, M.; Emre, Sükrü; Shneider, Benjamin L.; Kerkar, Nanda; Cuéllar, Santiago; Lobritto, Steven; Smith, Lizette J.; Harren, Patricia; Maseda, K.; Book, Linda S.; O’Gorman, Molly; Kawai, C; Bruschke, L.; Kraus, Jess F.; Álvarez, Fernando; Martin, Steven R.; Viau, Claude; Soriano, Humberto E.; Falkenstein, Kathleen; Shepherd, Ross W.; Lowell, Jeffrey A.; Nadler, Michelle; So, Samuel; Berquest, W.; Castillo, Majin; Bu-la, A; Karpen, Saul J.; Mayo, J. M. Calbo; Goss, John A.; Fishman, Douglas S.; Mclin, Valérie Anne; Carter, B.; O’Mahony, Christine A.; Aloia, Thomas A.; Garner, Daniel; McDiarmid, Sue V.; Fiest, S.; Gilmour, Susan; Dodd, Barbara; Kneteman, N.; Lavine, Joel E.; Khanna, Ajai; Clawson, R.; Rosenthal, Philip; Filipowski, Danuta; Boone, P.; González‐Peralta, Regino P.; Hemming, Alan W.; Hodik, Marcia; McCracken, Stuart; Tzakis, Andreas G.; Kato, Tomoaki; Weppler, Deborah; Cooper, Lebron; Gonzalez, M.; Santiago, Alba; López, J. J. Bravo; Magee, John C.; Shieck, Victoria; Humar, Abhinav; Durand, Brenda; Studenski, L.; Langnas, Alan Norman; Antonson, Dean L.; Botha, Jean F.; Grant, Wendy J.; Sudan, Debra L.; Andersen, Deborah; Fleckten, Beverly; Seipel, Katja; Fair, Jeffrey H.; Lichtman, Steven N.; Andreoni, Kenneth A.; Prinzhorn, J.; Buchholz, Valorie; Abt, Peter L.; Shisler, T.; Mack, Cara L.; Halff, Glenn A.; Wallace, Susannah Kish; Horslen, Simon; Young, Michael T.; Kalayoğlu, Münci; D'Alessandro, A M; Erickson, Nissa; Judo, R.; Knechtle, Stuart J.; E, Spaith

doi:10.1097/sla.0b013e3180caa415

Cited by 213 publications

(61 citation statements)

References 28 publications

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“…[34][35][36] Some transplant surgeons were initially reluctant to use these graft techniques for pediatric recipients, but more recent reports support continued efforts to improve surgical techniques of reduced size, live donor, and split liver grafts. 33,37 Increased use of split livers is quantitatively the most important component of this equation.…”

Section: Figurementioning

confidence: 99%

Pediatric Organ Donation and Transplantation

et al. 2013

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BACKGROUND AND OBJECTIVES: There is increasing unmet need for solid organ donation. Alternative donor sources, such as donation after circulatory determination of death (DCDD), are needed. The objective of this study was to examine the impact of DCDD on trends in pediatric organ donation and transplantation. METHODS: Data were obtained from the Organ Procurement and Transplantation Network for US organ recipients and donors from 2001 to 2010 stratified according to age, organ, and deceased donor type (DCDD or donation after neurologic determination of death). Additional data included transplant wait-list removals due to death. RESULTS: From 2001 to 2010, pediatric organ transplant recipients increased from 1170 to 1475. Organs from DCDD donors were transplanted into children infrequently but increased from 1 to 31. Pediatric donation after neurologic determination of death decreased by 13% whereas DCDD increased by 174% (50 to 137). Recipients of pediatric grafts decreased from 3042 to 2751. Adults receiving grafts from pediatric donors decreased from 2243 to 1780; children receiving pediatric grafts increased from 799 to 971. Transplant recipients receiving pediatric DCDD grafts were few but increased annually from 50 to 128 adults and 0 to 9 children. Pediatric candidates dying waiting for an organ decreased from 262 to 110. CONCLUSIONS: From 2001 to 2010, children received more solid organ transplants and fewer children died waiting. Organ recovery from pediatric and adult DCDD donors increased. The number of pediatric recipients of DCDD grafts remains small. Adults primarily receive the direct benefit from pediatric DCDD but other changes in organ allocation have directly benefited children.

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Section: Figurementioning

confidence: 99%

Pediatric Organ Donation and Transplantation

et al. 2013

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“…14,15 The SPLIT registry report on 1 611 patients showed 1-year patient and graft survival rates of 88% and 82%, respectively. 16 Age at diagnosis, severity of illness, and possibly the technical variants of grafts utilised (reduced-size and split grafts), may be associated with increased morbidity and decreased overall survival. 17 Ng et al reported second and third transplantation rates of 12% and 2%, respectively, 5% chronic rejection, and 6% post-transplant lymphoproliferative disease in their paediatric LT cohort.…”

Section: Outcome and Graft Survival Following Ltmentioning

confidence: 99%

Selection and work-up for liver transplantation

Zuckermann

Loveland

2012

S Afr Med J

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The primary goal of evaluating patients for liver transplantation (LT) is to identify appropriate candidates and establish a pre-transplantation plan. Prospective patients must first be referred to a transplantation centre for evaluation and, if deemed suitable, for work-up, with a view to being listed for transplantation. South Africa has centres offering LT in Johannesburg and Cape Town. Typically, referred patients are evaluated by a clinician, and further evaluations and tests are performed before the patient is discussed at a multidisciplinary transplantation meeting. Initiating the referral early in the course of disease facilitates improved outcomes, by allowing earlier LT before the establishment of end-stage disease. It is also well described that patients awaiting transplantation (and their families) demonstrate better psychological adaptation when the entire spectrum of issues is approached by a multidisciplinary clinical team.1 It is not uncommon for children to exhibit behavioural problems, depression, poor social adaptation and non-compliance after transplantation, which can be moderated by early counselling after referral. 2 Purpose and policyOrgan availability is the rate-limiting step regarding successful transplantation and a reduction in waiting-list mortality. This is particularly applicable in centres that do not have related living donor programmes, but rely solely on deceased donor organs. Consequently, the decision-making and selection process must be transparent, and a consistent set of evidence-based criteria must be applied to determine whether selection for transplantation is appropriate. IndicationsBorne out by our experience, approximately 50% of paediatric patients requiring LT have biliary atresia.2 However, the indications for LT fall into 5 major categories of liver disease: (i) cholestatic diseases; (ii) metabolic disorders; (iii) fulminant liver failure; (iv) auto-immune hepatitis; and (v) liver tumours. General listing criteriaInfants and children should be listed for LT when there is evidence that hepatic decompensation has occurred, is imminent, or is inevitable based on the natural history of the disease. Clinical endpoints that determine suitability for transplantation may include one or more of the following: severe cholestasis; portal hypertension with/without variceal bleeding; multiple episodes of ascending cholangitis; failure of hepatic synthetic function; malnutrition and failure to thrive; intractable ascites; encephalopathy; unacceptably poor quality of life due to liver disease; and life-threatening complications of stable liver disease, such as hepatopulmonary syndrome. Pre-LT assessment and work-upThe first step in evaluating a potential candidate for LT is to determine the severity and prognosis of the liver disease. A subjective clinical assessment is undertaken together with an objective assessment including comprehensive laboratory and radiological evaluations. The aim of this is to: (i) identify contra-indications that would either exclude LT, require dis...

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“…Sa fréquence est de l'ordre de 3 % après greffe d'un foie de donneur en mort encéphalique [8,[14][15][16]. Elle est exceptionnelle lorsque le prélèvement du greffon est réalisé chez l'un des 2 parents en raison notamment de la plus courte durée de l'ischémie froide du greffon [8,9,17].…”

Section: Dysfonction Primaire Du Greffonunclassified

“…La fréquence de la thrombose de l'artère hépatique après TH chez l'enfant est de 3 % à 17 % selon les publications [8,9,[14][15][16][17]. Dans notre expérience personnelle, elle est plus fréquente lorsque la somme des poids du donneur et du receveur est < 20 kg (figure 2).…”

Section: Complications Vasculairesunclassified

“…Les conséquences sont soit une nécrose massive du foie imposant une retransplantation hépatique en extrême urgence, soit une cholangiopathie ischémique pouvant faire poser l'indication d'une retransplantation à court ou moyen terme en raison de complications infectieuses (cholangites bactériennes itératives) et du développement d'une cirrhose biliaire. La fréquence des complications portales varie de 2 à 11 % selon les séries [8,9,[14][15][16][17]. La thrombose de la veine porte s'observe plus particulièrement chez l'enfant greffé pour une AVB qui a souvent une hypoplasie de la veine porte.…”

Section: Complications Vasculairesunclassified

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