Outcomes and technical aspects of liver retransplantation with living donors in children

Abstract

Re-LT is the only recourse for patients with liver graft failure. However, survival rates after re-LT are lower than those of primary transplants. Few reports are available regarding re-LT with LDs in children. The objective of this study was to describe our cohort of patients retransplanted with LD and emphasize the technical aspects of a re-LT with LD. This is a retrospective report of a series of 18 children (<18 yr old) submitted to 20 re-LT from January 1997 to December 2013 at Hospital Sirio-Libanes and Hospital AC Camargo Cancer Center. The one- and five-yr survival for patients retransplanted with LD was 70.6% and 58.6%. Little technical modifications from a regular LD primary transplant were needed in patients retransplanted with LD. Seven (38.8%) patients presented vascular complications following re-LT and three presented biliary complications (16.6%). In conclusion, a re-LT with LD is an acceptable alternative for children who experience liver graft failure and it does not compromise the donor pool. Further experience with re-LT with LD may support this therapy.

The outcomes of pediatric liver retransplantation from a living donor: a 17-year single-center experience

“…Previous studies reported that the incidence of hepatic artery thrombosis (HAT) after pediatric retransplantation is up to 10% [23][24][25]. HAT might lead to fatal graft failure and should be avoided to allow the patient to survive the acute phase after Re-LDLT [26]. None of the Re-LDLT cases in our study involved the development of postoperative HAT; the introduction of microsurgical reconstruction might have contributed to this good result.…”

Good outcomes after repeated pediatric liver retransplantations: A justified procedure even in times of organ shortage

“…Although primary LT and late reLTs showed no relevant difference in complete operation time, early reLTs were significantly shorter procedures. Given the shortage of donor organs and reported reduced survival rates for pediatric reLT, [5][6][7][8][9] indications for pediatric reLT are discussed controversially. 1,2,[5][6][7] Here we report long-term survival rates of >80%; despite critical patient situations, this survival rate reLT for pediatric recipients is similar to survival rates for adult recipients (76%-82%), 19 which suggests justifiable use of organs even in this time of severe organ shortages.…”

“…[1][2][3][4][5][6][7][8] From a surgical perspective, reLT can be challenging due to massive adhesions, critical patient condition and lack of appropriate vessels for anastomosis. [5][6][7][8][9] Given the shortage of donor organs and reportedly reduced survival rates for pediatric reLT, indications for pediatric reLT are discussed controversially. 1,2,[5][6][7] Indeed, because improved patient outcomes have been achieved by better perioperative management and modern immunosuppression regimens, 1,7,8 multiple reLTs for one recipient are uncommon.…”

In vitro fertilization: an unexpected finding in a cohort of patients with biliary atresia

“…Technical aspects and outcomes in primary LT ( 12 , 13 ) and retransplantation ( 14 ) performed by our transplantation team were previously published and are not included in the present article.…”