Results of Split Liver Transplantation in Children

Deshpande, Rahul; Bowles, Matthew; Vilca‐Melendez, Hector; Srinivasan, Parthi; Girlanda, Raffaele; Dhawan, Anil; Mieli‐Vergani, Giorgina; Muiesan, Paolo; Heaton, Nigel; Rela, Mohamed

doi:10.1097/00000658-200208000-00014

Cited by 98 publications

(64 citation statements)

References 29 publications

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“…11 The use of technical variant grafts increases this risk. 23,24 In our experience, reoperations in these already unstable neonates often precipitate medical complications such as renal failure. Such complications may perpetuate themselves and ultimately lead to the patient's death.…”

Section: Operative and Postoperative Considerationsmentioning

confidence: 90%

Liver transplantation in neonates

Sundaram

Alonso

Whitington

2003

Liver Transplantation

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Orthotopic liver transplantation (OLT) has evolved over the past two decades to become the standard of care for end-stage liver disease in infants and children. Technical advances, particularly the use of technical variant allografts, have permitted extension of OLT into a much younger and smaller population than previously possible. Major centers around the world now routinely perform OLT in infants with survival success equivalent to that in older children and adults. We are beginning to see a small population of school-aged children who were infant OLT recipients. The further extension of OLT into neonates is more recent, with only a few pediatric centers reporting survival success. Very little is known about this frontier of transplantation. Our intent is to provide an overview of neonatal OLT using all available data and our experience in the field. (Liver Transpl 2003;9:783-788.)F or the purpose of this review, neonatal orthotopic liver transplantation (OLT) is defined as transplantation performed in the first three months of life. This does not coincide with the usual definition of the neonate, infants in their first month of life. The extension to three months is necessary, however, because of the manner in which data regarding pediatric OLT have been collated. This division also holds because most diseases necessitating neonatal OLT produce liver failure at or near the time of birth. United Network for Organ Sharing (UNOS) data show that in 2001, 623 pediatric OLTs were performed in the United States. Of these transplantations, 167 were performed in children younger than one year of age and only eight in neonates. The number of neonatal OLT procedures has been varied over the past four years from eight to 14, with the peak in 2000. Patient and graft survival, 57% and 38% respectively, remain significantly lower than that of older children. 1,2 UNOS data show that infants three to 12 months old have graft and patient survival of 72.8 % and 82.1%, respectively. Children aged one to five years have 76.8% graft and 84.1% patient survival, and those older than six years have greater than 82% graft and 91% patient survival. These data demonstrate that transplantation in neonates presents unique medical and technical challenges. The complexities of liver transplantation in this age group have received relatively little attention in the medical literature. This review details the common indications for transplantation, addresses the multiple obstacles to successful transplantation, and explores strategies to improve survival and long-term outcomes in neonatal recipients. Defining the ProblemThe age distribution of reported neonatal OLTs is evenly distributed across the first three months of life. Woodle et al reported a series of 23 neonatal OLTs performed at three US centers: 28% were less than one month old, 35% were one to two months old, and 36% were two to three months old at the time of transplantation. 2 The youngest infant reported to undergo liver transplant was five days old. 3 The typical body weight...

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Section: Operative and Postoperative Considerationsmentioning

confidence: 90%

Liver transplantation in neonates

Sundaram

Alonso

Whitington

2003

Liver Transplantation

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“…Potential problems associated with ex vivo splitting include prolonged cold ischemia time, poorer definition of the biliary tree, less precise hemostatic control and poorer overall results for right-sided grafts compared to those obtained by in situ splitting [87]. In situ splitting increases organ retrieval time by approximately 2 h [88]. The Pittsburgh group found no overall difference in 1-year patient and graft survival between in situ and ex vivo split transplants in their center and concluded that either form of split transplantation resulted in acceptable results [67].…”

Section: Split Liver Transplantationmentioning

confidence: 99%

Partial liver transplantation-living donor liver transplantation and split liver transplantation

Müller

Mehrabi

Schmied

et al. 2007

Nephrology Dialysis Transplantation

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In the last two decades, liver transplantation (LTx) has become the treatment of choice for several liver diseases including hepatocellular carcinoma in selected cases. Improvements in surgical and anesthesiological procedures have increased patient survival after LTx, resulting in excellent 1-year survival rates. The ratelimiting factor to further increase the number of LTx is the extreme shortage of suitable organs with the consequence that pediatric and adult patients are dying on the waiting list. At present, mortality reported for pediatric and adult patients on the waiting list is 10 to 20%. Living-donor liver transplantation and split liver transplantation are measurements to reduce the severe lack of cadaveric grafts by expanding the donor pool. Major centers around the world now routinely perform partial LTx in infants and adults with survival success equivalent to that after full-size liver transplantation.

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“…Liver mass is controlled in an intriguingly exact way, which becomes essential in situations where transplanted livers that are too small for matching the body weight of the recipient have to grow until they reach their optimal size, whereas transplants that are too big in size shrink to their optimal volume (3)(4)(5).…”

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confidence: 99%

Molecular Dissection of gp130-dependent Pathways in Hepatocytes during Liver Regeneration

Dierssen

Beraza

Lutz

et al. 2008

Journal of Biological Chemistry

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Interleukin-6 (IL-6) via its signal transducer gp130 is an important mediator of liver regeneration involved in protecting from lipopolysaccharide (LPS)-induced liver injury after partial hepatectomy (PH). Here we generated mice either defective (⌬) in hepatocyte-specific gp130-dependent Ras or STAT activation to define their role during liver regeneration. Deletion of gp130-dependent signaling had major impact on acute phase gene (APG) regulation after PH. APG expression was blocked in gp130-⌬STAT animals, whereas gp130-⌬Ras mice showed an enhanced APG response and stronger SOCS3 regulation correlating with delayed hepatocyte proliferation. To define the role of SOCS3 during hepatocyte proliferation, primary hepatocytes were co-stimulated with IL-6 and hepatocyte growth factor. Higher SOCS3 expression in gp130-⌬Ras hepatocytes correlated with delayed hepatocyte proliferation. Next, we tested the impact of LPS, mimicking bacterial infection, on liver regeneration. LPS and PH induced SOCS3 and APG in all animal strains and delayed cell cycle progression. Additionally, IL-6/gp130-dependent STAT3 activation in hepatocytes was essential in mediating protection and thus required for maximal proliferation. Unexpectedly, oncostatin M was most strongly induced in gp130-⌬STAT animals after PH/LPS-induced stress and was associated with hepatocyte proliferation in this strain. In summary, gp130-dependent STAT3 activation and concomitant SOCS3 during liver regeneration is involved in timing of DNA synthesis and protects hepatocyte proliferation during stress conditions.

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Results of Split Liver Transplantation in Children

Abstract: These results, which represent the experience of a single institution over the last 6 years, indicate that ex situ split liver transplantation can be performed in children with good overall outcome and acceptable morbidity.

Cited by 98 publications

References 29 publications

Liver transplantation in neonates

Liver transplantation in neonates

Partial liver transplantation-living donor liver transplantation and split liver transplantation

Molecular Dissection of gp130-dependent Pathways in Hepatocytes during Liver Regeneration

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