Living donor liver retransplantation for primary non-function of liver graft following multivisceral transplantation in a pediatric patient

Abstract

Multivisceral organ transplantation (MVOT) includes transplantation of three or more abdominal organs, generally including the small bowel, duodenum, stomach, liver, pancreas, and colon. We here presented the detailed procedures of repeat living donor liver transplantation for primary non-function of the first liver graft following MVOT in a pediatric patient. A 6-year-old girl with chronic intestinal pseudo-obstruction underwent MVOT with 5-year-old donor organs. However, the primary non-function of the liver graft developed, and an emergency living donor liver transplantation operation using a left lateral section graft was performed on the third day after MVOT. The donor was the patient's father. Portal flow interruption induced ischemic congestion of the whole small bowel, thus we used a series of porto-caval shunt to reduce the risk of ischemic splanchnic congestion during recipient hepatectomy and graft implantation. Other surgical procedures were the same as the standardized procedures for left liver graft implantation. The graft-recipient weight ratio was 2.15. The patient was managed conservatively for 3 months and discharged in an improved condition at 4 months after MVOT. She finally passed away at 22 months after MVOT. We think that our experience will be helpful for surgeons to cope with portal vein clamping-associated splanchnic congestion during liver transplantation and other abdominal surgeries.

Korea-nationwide incidence of pediatric deceased donors and single-institutional status of liver transplantation using pediatric donor liver grafts

“…3A ). There was only one case of pediatric liver retransplantation using a living donor liver graft following multivisceral transplantation at the third post-transplant day [ 5 ]. The overall patient survival rates at 1, 3, and 5 years were 90.9%, 80.8%, and 80.8%, respectively in the pediatric-to-pediatric DDLT group and 69.6%, 58.4%, and 58.4%, respectively in the pediatric-to-adult DDLT group (P=0.21) ( Fig.…”

Pediatric liver transplantation using a hepatitis B surface antigen-positive donor liver graft for congenital absence of the portal vein

“…Significant splanchnic congestion may occur when a PCS is totally clamped during portal vein reconstruction, resulting in severe bowel edema and hemodynamic instability. We have previously experienced a similar situation during early liver retransplantation after multivisceral transplantation in a pediatric patient [ 15 ]. The use of a temporary PCS during LT operation can improve hemodynamic status and reduce intraoperative transfusion requirement.…”