Pediatric Liver Transplantation

Tiao, Greg; Ryckman, Frederick C.

doi:10.1016/j.cld.2005.10.004

Cited by 10 publications

(7 citation statements)

References 91 publications

(103 reference statements)

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“…Starzl et al (2) succeeded 4 years later with the first recipient who had significant survival. Since then, survival rates have improved because of advances in surgical techniques, organ preservation, pediatric intensive care, and immunosuppressive therapy (3). Furthermore, advances in radiology and the inclusion of radiologists on the multidisciplinary team have added value in the early diagnosis of complications, which also has contributed to improved patient outcomes (4,5).…”

Section: Sa-cme Learning Objectives Introductionmentioning

confidence: 99%

Pediatric Liver Transplant: Techniques and Complications

et al. 2017

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Liver transplant is considered to be the last-resort treatment approach for pediatric patients with end-stage liver disease. Despite the remarkable advance in survival rates, liver transplant remains an intricate surgery with significant morbidity and mortality. Early diagnosis of complications is crucial for patient survival but is challenging given the lack of specificity in clinical presentation. Knowledge of the liver and vascular anatomy of the donor and the recipient or recipients before surgery is also important to avoid complications. In this framework, radiologists play a pivotal role on the multidisciplinary team in both pre- and postoperative scenarios by providing a road map to guide the surgery and by assisting in diagnosis of complications. The most common complications after liver transplant are (a) vascular, including the hepatic artery, portal vein, hepatic veins, and inferior vena cava; (b) biliary; (c) parenchymal; (d) perihepatic; and (e) neoplastic. The authors review surgical techniques, the role of each imaging modality, normal posttransplant imaging features, types of complications after liver transplant, and information required in the radiology report that is critical to patient care. They present an algorithm for an imaging approach for pediatric patients after liver transplant and describe key points that should be included in radiologic reports in the pre- and postoperative settings. Online supplemental material is available for this article. RSNA, 2017.

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Section: Sa-cme Learning Objectives Introductionmentioning

confidence: 99%

Pediatric Liver Transplant: Techniques and Complications

et al. 2017

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“…Patient survival has improved in recent decades: overall 1‐year survival rates currently approach 90%, whereas rates were <70% before 1980 . Research examining risk factors for patient and graft survival following LT have focused on recipient, donor, and intraoperative variables as well as posttransplant treatments and complications . Although many studies have included race/ethnicity in demographic risk stratification when the data have been available, health disparities in transplant outcomes have not been studied in depth in the pediatric LT recipient population.…”

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confidence: 99%

Racial and socioeconomic disparities in pediatric and young adult liver transplant outcomes

et al. 2013

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Racial and socioeconomic disparities exist in liver transplantation (LT) outcomes among adults, but little research exists for pediatric LT populations. We examined racial differences in graft survival and mortality within a retrospective cohort of pediatric and young adult LT recipients at a large children's transplant center in the Southeast between 1998 and 2011. The association between race/ethnicity and rates of graft failure and mortality was examined with Cox proportional hazards models that were adjusted for demographic and clinical factors as well as individual-level and census tract–level socioeconomic status (SES). Among the 208 LT recipients, 51.0% were white, 34.6% were black, and 14.4% were other race/ethnicity. Graft survival and patient survival were higher for whites versus minorities 1, 3, 5, and 10 years after transplantation. The 10-year graft survival rates were 84% [95% confidence interval (CI) = 76%-91%] for white patients, 60% (95% CI = 46%-74%) for black patients, and 49% (95% CI = 23%-77%) for other race/ethnicity patients. The 10-year patient survival rates were 92% (95% CI = 84%-96%), 65% (95% CI = 52%-79%), and 76% (95% CI = 54%-97%) for the white, black, and other race/ethnicity groups, respectively. In analyses adjusted for demographic, clinical, and socioeconomic characteristics, the rates of graft failure [black: hazard ratio (HR) = 2.59, 95% CI = 1.29-5.45; other: HR = 3.01, 95% CI = 1.23-7.35] and mortality (black: HR = 4.24, 95% CI = 1.54-11.69; other: HR=3.09, 95% CI= 0.78-12.19) were higher for minority groups versus whites. In conclusion, at a large pediatric transplant center in the Southeastern United States, racial/ethnic disparities exist in pediatric and young adult LT outcomes that are not fully explained by measured SES and clinical factors.

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“…Prior operation for biliary atresia or multiple episodes of spontaneous bacterial peritonitis lead to extensive adhesions, increasing the risk of intestinal perforation and bleeding at hepatectomy. [4] However, our case did not bleed much even in the presence of adhesions due to slow but meticulous surgery.…”

Section: Discussionmentioning

confidence: 68%