Living Donor Liver Transplantation in Children

Gurevich, Michael; Guy-Viterbo, Vanessa; Janssen, M.; Stéphenne, Xavier; Smets, Françoise; Sokal, Étienne; Lefèbvre, Chantal; Balligand, Jean‐Luc; Pirotte, Thierry; Veyckemans, Francis; Clapuyt, Philippe; Menten, Renaud; Dumitriu, Dana; Danse, Étienne; Annet, Laurence; Cléty, Stéphan Clément de; Detaille, Thierry; Latinne, Dominique; Sempoux, Christine; Laterre, Pierre‐François; Magnée, Catherine De; Lerut, Jan; Reding, Raymond

doi:10.1097/sla.0000000000001094

Cited by 66 publications

(27 citation statements)

References 44 publications

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“…Excellent outcomes after LDLT in children have previously been reported from the Japanese and Eurotransplant registry data, and single-center experiences from large pediatric programs in Europe and Asia. 34-37 Graft survival at 3 years post pediatric LDLT have been reported as 90.7% and patient survival at 3 years have been reported at 91.4%. 19 Data from Japanese Liver Transplant Society, the largest pediatric LDLT cohort in the world, demonstrate 5- and 20-year patient survival rates of 85.4% and 79.6%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Superior Outcomes and Reduced Wait Times in Pediatric Recipients of Living Donor Liver Transplantation

Kehar

Parekh

Stunguris

et al. 2019

Transplantation Direct

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Section: Discussionmentioning

confidence: 99%

Superior Outcomes and Reduced Wait Times in Pediatric Recipients of Living Donor Liver Transplantation

Kehar

Parekh

Stunguris

et al. 2019

Transplantation Direct

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“…Gurevich et al[ 25 ] examined 58 pediatric patients undergoing AB0i LDLT with a preoperative iso-titer of < 1:16. No graft rejection or death occurred and 93% survived beyond the first 10 years.…”

Section: Indications For Ab0i Ldlt With Special Reflexionsmentioning

confidence: 99%

“…Patients with biliary atresia had fewer rejection episodes in situations where the graft was donated by the mother (mother:father vs 40%:55%)[ 25 - 27 ]. Most data in children have been collected in Asia[ 25 , 28 ]. Okada et al[ 29 ] described rituximab to be successful in pediatric AB0i LDLT.…”

Section: Indications For Ab0i Ldlt With Special Reflexionsmentioning

confidence: 99%

Current techniques for AB0-incompatible living donor liver transplantation

Rummler¹,

Bauschke²,

Barthel³

et al. 2016

WJT

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For a long time, it was considered medical malpractice to neglect the blood group system during transplantation. Because there are far more patients waiting for organs than organs available, a variety of attempts have been made to transplant AB0-incompatible (AB0i) grafts. Improvements in AB0i graft survival rates have been achieved with immunosuppression regimens and plasma treatment procedures. Nevertheless, some grafts are rejected early after AB0i living donor liver transplantation (LDLT) due to antibody mediated rejection or later biliary complications that affect the quality of life. Therefore, the AB0i LDLT is an option only for emergency situations, and it requires careful planning. This review compares the treatment possibilities and their effect on the patients’ graft outcome from 2010 to the present. We compared 11 transplant center regimens and their outcomes. The best improvement, next to plasma treatment procedures, has been reached with the prophylactic use of rituximab more than one week before AB0i LDLT. Unfortunately, no standardized treatment protocols are available. Each center treats its patients with its own scheme. Nevertheless, the transplant results are homogeneous. Due to refined treatment strategies, AB0i LDLT is a feasible option today and almost free of severe complications.

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“…The chances of diagnosis decrease when paired with the age of the patients due to the size of the vessels and the minimal flow that the method used could detect. Many patients with BA have hypoplasia or anatomical malformations of the portal vein; this has been reported as a risk factor for post‐transplant complications . Portal vein thrombosis due to portal hypoplasia is the most frequent complication, with a reported incidence between 4% and 16% …”

Section: Discussionmentioning

confidence: 99%

Unusual spontaneous porto‐systemic shunt: The importance of diagnosing non‐anatomical porto‐systemic shunts to improve portal flow in pediatric living–related liver transplantation. Case report

Rubio

Rumbo

Farinelli

et al. 2018

Pediatric Transplantation

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Collateral circulation secondary to liver cirrhosis may cause the development of large PSSs that may steal flow from the main portal circulation. It is important to identify these shunts prior to, or during the transplant surgery because they might cause an insufficient portal flow to the implanted graft. There are few reports of "steal flow syndrome" cases in pediatrics, even in biliary atresia patients that may have portal hypoplasia as an associated malformation. We present a 12-month-old female who received an uneventful LDLT from her mother, and the GRWR was 4.8. During the early post-operative period, she became hemodynamically unstable, developed ascites, and altered LFT. The post-operative ultrasound identified reversed portal flow, finding a non-anatomical PSS. A 3D CT scan confirmed the presence of a mesocaval shunt through the territory of the right gonadal vein, draining into the right iliac vein, with no portal inflow into the liver. The patient was re-operated, and the shunt was ligated. An intraoperative Doppler ultrasound showed adequate portal inflow after the procedure; the patient evolved satisfactorily and was discharged home on day number 49. The aim was to report a case of post-operative steal syndrome in a pediatric recipient due to a mesocaval shunt not diagnosed during the pretransplant evaluation.

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Living Donor Liver Transplantation in Children

Abstract: LDLT, including ABO-mismatched transplantation, constitutes a safe and efficient therapy for liver failure in children. In BA patients with PV hypoplasia, portoplasty seems to constitute the best technique for PV reconstruction. Maternal donation might be a protective factor for AR.

Cited by 66 publications

References 44 publications

Superior Outcomes and Reduced Wait Times in Pediatric Recipients of Living Donor Liver Transplantation

Superior Outcomes and Reduced Wait Times in Pediatric Recipients of Living Donor Liver Transplantation

Current techniques for AB0-incompatible living donor liver transplantation

Unusual spontaneous porto‐systemic shunt: The importance of diagnosing non‐anatomical porto‐systemic shunts to improve portal flow in pediatric living–related liver transplantation. Case report

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