Living donor liver transplantation with body-weight more or less than 10 kilograms

Abstract

AIM:To compare the outcomes of pediatric patients weighing less than or more than 10 kg who underwent liver transplantation. METHODS: Data for 196 pediatric patients who underwent living donor liver transplantation betweenJune 1994 and February 2011 were reviewed retrospectively. The information for each patient was anonymized and de-identified before analysis. The data included information regarding the pre-transplant conditions, intraoperative fluid replacement and outcomes for each patient. The 196 patients were divided into two groups: those with body weights of less than 10 kg were included in group 1 (G1; n = 101), while those with body weights of more than 10 kg were included in group 2 (G2; n = 95). For each group, the patients' ages, body weights, heights, pediatric end stage liver disease scores, anesthesia times, and warm and cold ischemic times were analyzed. In addition, between-group comparisons were also made. Mann-Whitney U tests were used to compare all the variables except for complications and survival rates, which were analyzed using χ 2 tests and Kaplan-Meier tests, respectively. RESULTS:The general medical conditions of the G1 Retrospective StudyLiving donor liver transplantation with body-weight more or less than 10 kilograms patients were worse than those of the G2 patients, as shown by the higher pediatric end stage liver disease scores and poorer Z -scores. In addition, the preoperative Hb and serum albumin levels were all lower for the G1 patients than for the G2 patients. The G1 patients also had significantly more intraoperative blood loss than the G2 patients. In addition, the intraoperative fluid requirements for the G1 patients, including leukocyte poor red blood cell transfusions, 5% albumin infusions and crystalloid infusions, were significantly higher than those for the G2 patients. The risk of intraoperative portal vein thrombosis was higher for the patients in G1 than for those in G2. However, the one-year survival rates (95.9% and 96.8% for G1 and G2, respectively) and three-year survival rates (94.9% and 94.6% for G1 and G2, respectively) for both groups were similar. CONCLUSION:Patients weighing less than 10 kg typically have poorer conditions, but their survival rates are comparable to those of children weighing more than 10 kg. Core tip: Although pediatric patients weighing less than 10 kg who underwent living donor liver transplantation usually had worse pre-transplant conditions, more intraoperative bleeding and more portal vein complications, their three-year survival rate was 94%, a rate comparable to that achieved by children weighing more than 10 kg. A prerequisite for achieving these excellent results is good and effective teamwork. Cooperation between surgeons, plastic surgeons, and anesthesiologists in the operating theater is fundamental, but the contributions of radiologists are also critical. Radiologists should be available in the operating room to perform Doppler ultrasounds or place vascular stents, as required.Yang SC, Huang CJ, Chen CL, Wang CH,...

Hepatic venous reconstruction of the left lateral segment with emphasis on anomalous hepatic vein in pediatric liver transplantation

“…The mean weight of the transplanted children in this cohort was below 10 kg, a population that presents technical difficulties in vascular reconstruction during liver transplantation, as well as in perioperative care, as pointed out by some authors 17,18 . In the present study, as shown in Table 1, there was no difference in the characteristics of the recipients between the types of LLS grafts used, related to the age and weight at LT, as well as the severity of liver disease by PELD score and presence of ascites.…”

Living Donor Liver Transplantation vs. Split Liver Transplantation Using Left Lateral Segment Grafts in Pediatric Recipients: An Analysis of the UNOS Database

“…Subgroup analyses were performed to better understand the challenges associated with low body weight (<10 kg) of pediatric recipients and younger age at the time of transplant (<10 years old). Historically, weight above 10 kg has been predictive of graft survival and associated with improved outcomes ( 10 , 28 ). Smaller recipient size increases the technical complexity of the surgery and has been associated with higher rates of vascular and biliary complications ( 29 ).…”

Biliary atresia: Indications and timing of liver transplantation and optimization of pretransplant care

“…In addition, LDLT allows for procurement from a healthy donor with elective scheduling of the operation and shorter cold ischemia times . Excellent patient survival, comparable to older children, is seen even in very young (<90 days old) and small (<10 kg) infants transplanted at experienced pediatric centers . A Markov model simulation found an increase of 17.45 additional expected life‐years when a LDLT was performed in a patient with a PELD of 15‐25 with 1 or fewer systemic complication as compared with those with PELD scores >25 who had more than 1 systemic complication .…”