One Thousand Pediatric Liver Transplants During Thirty Years: Lessons Learned

Venick, Robert S.; Farmer, Douglas G.; Soto, José R.; Vargas, Jorge; Yersiz, Hasan; Kaldas, Fady M.; Agopian, Vatche G.; Hiatt, Jonathan R.; McDiarmid, Sue V.; Busuttil, Ronald W.

doi:10.1016/j.jamcollsurg.2017.12.042

Cited by 77 publications

(77 citation statements)

References 69 publications

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“…[1][2][3] However, access to timely LT is challenging for children due to the scarcity of size-matched pediatric deceased donors. [1][2][3] However, access to timely LT is challenging for children due to the scarcity of size-matched pediatric deceased donors.…”

Section: Liver Transplantation (Lt) Is An Established Life-saving Trementioning

confidence: 99%

Pediatric living donor liver transplantation with large-for-size left lateral segment grafts

Goldaracena

Echeverri

Kehar

et al. 2020

American Journal of Transplantation

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Usage of “large‐for‐size” left lateral segment (LLS) liver grafts in children with high graft to recipient weight ratio (GRWR) is controversial due to concerns about increased recipient complications. During the study period, 77 pediatric living donor liver transplantations (LDLTs) with LLS grafts were performed. We compared recipients with GRWR ≥2.5% (GR‐High = 50) vs GRWR <2.5% (GR‐Low = 27). Median age was higher in the GR‐Low group (40 vs 8 months, P> .0001). Graft (GR‐High: 98%, 98%, 98% vs GR‐Low: 96%, 93%, 93%) and patient (GR‐High: 98%, 98%, 98% vs GR‐Low: 100%, 96%, 96%) survival at 1, 3, and 5 years was similar between groups (P = NS). Overall complications were also similar (34% vs 30%; P = .8). Hepatic artery and portal vein thrombosis following transplantation was not different (P = NS). Delayed abdominal fascia closure was more common in GR‐High patients (17 vs 1; P = .002). Subgroup analysis comparing recipients with GRWR ≥4% (GR‐XL = 20) to GRWR <2.5% (GRWR‐Low = 27) revealed that delayed abdominal fascia closure was more common in the GR‐XL group, but postoperative complications and graft and patient survival were similar. We conclude that pediatric LDLT with large‐for‐size LLS grafts is associated with excellent clinical outcomes. There is an increased need for delayed abdominal closure with no compromise of long‐term outcomes. The use of high GRWR expands the donor pool and improves timely access to the benefits of transplantation without extra risks.

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Section: Liver Transplantation (Lt) Is An Established Life-saving Trementioning

confidence: 99%

Pediatric living donor liver transplantation with large-for-size left lateral segment grafts

Goldaracena

Echeverri

Kehar

et al. 2020

American Journal of Transplantation

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“…Although over time there has been a trend toward better survival in patients undergoing eRe‐LT, results are still significantly worse than after a first transplantation . Also, results in patients undergoing eRe‐LT are consistently worse than in those who undergo late re‐LT, and prognosis in the eRe‐LT patients is also worse than in those with the other classical indication for urgent LT: acute liver failure …”

Section: Discussionmentioning

confidence: 99%

“…In a large single‐center series of children undergoing LT, Venick et al found that eRe‐LT was an independent prognostic factor for poor outcome . Ng et al reported the results of re‐LT in children registered in the Studies of Pediatric Liver Transplantation database from the United States .…”

Section: Discussionmentioning

confidence: 99%

“…In patients with a PELD/MELD score between 15 and 34, the additional need for advanced life support diminishes the chances of survival, and it would be valuable to wait and see if the patient’s critical condition improves, which would enhance the chances of survival. Lastly, patients with a MELD/PELD score of <15 have the best chances of survival, regardless of the need for life support …”

Section: Discussionmentioning

confidence: 99%

“…Liver transplantation (LT) has been the standard of care for end‐stage liver disease, acute liver failure, and some inborn errors of metabolism over the last decades. Urgent liver retransplantation may be the only therapeutic option when the graft fails in the early posttransplant period, and it accounts for 10%‐43% of pediatric and 52% of adult re‐LT series worldwide . Patients who face an urgent re‐LT are typically in a critical clinical condition that may affect their chances for survival.…”

mentioning

confidence: 99%

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Prognostic Factors in Pediatric Early Liver Retransplantation

Reyes¹,

Halac²,

Aredes³

et al. 2020

Liver Transpl

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The most common indications for early liver retransplantation (eRe‐LT) are vascular complications and primary nonfunction (PNF). These patients are usually in a critical clinical condition that can affect their chances of survival. In fact, the survival of these patients is usually lower compared with the patients undergoing a first transplant. To the best of our knowledge, no specific series of pediatric patients undergoing eRe‐LT has been published to date. Therefore, the aim of this study is to report the results of eRe‐LT and to analyze factors potentially related to success or failure. Our work is of a retrospective cohort study of patients who underwent eRe‐LT at the Juan P. Garrahan Pediatric Hospital of Buenos Aires, Argentina, between May 1995 and December 2018 (n = 60). Re‐LT was considered early when performed ≤30 days after the previous LT. A total of 40 (66.7%) patients were enrolled due to vascular causes and 20 (33.3%) were enrolled because of PNF. Of all the relisted patients, 36 underwent eRe‐LT, 14 died on the waiting list, and 10 recovered without eRe‐LT. A total of 23 (63.9%) patients died after eRe‐LT, most of them due to infection‐related complications. Survival rates at 1 and 5 years were 42.4% and 33.9%, respectively. On univariate logistic regression analysis, Pediatric End‐Stage Liver Disease (PELD)/Model for End‐Stage Liver Disease (MELD) scores, transplant era, and advanced life support at eRe‐LT were found to be related to 60‐day mortality. However, on multivariate analysis, era (odds ratio [OR], 9.3; 95% confidence interval [CI], 1.19‐72.35; P = 0.033) and PELD/MELD scores (OR, 1.07; 95% CI, 1‐1.14; P = 0.036) were significantly associated with 60‐day patient mortality. This study found that the level of acuity before retransplant, measured by the requirement of advanced life support and the PELD/MELD score at eRe‐LT, was significantly associated with the chances of post–eRe‐LT patient survival.

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