The effect of liver graft-body weight ratio on the core temperature of pediatric patients during liver transplantation

Abstract

The left lateral segment of the liver from an adult living donor sometimes is relatively too large for a small pediatric recipient. It currently is unknown whether a high graft-recipient body weight ratio (GRWR) has a significant effect on core temperature during the anhepatic and reperfusion phases of living donor liver transplantation (LDLT). Seventy-two pediatric patients undergoing LDLT were divided into two groups according to body weight. Group I (GI) consisted of patients with a body weight greater than 10 kg, and group II (GII), less than 10 kg. Core temperature, measured as nasopharyngeal temperature (NT), was compared between groups at induction of anesthesia, hourly during the following 6 hours, as the lowest core temperature at the anhepatic phase, 5 and 30 minutes after reperfusion, and the last 2 hours before the end of the operation. Mild hypothermia of 35.8°C ؎ 0.7°C and 35.9°C ؎ 0.4°C for GI and GII was noted after induction of anesthesia, respectively; this increased ؎1°C in the following 6 hours. In the anhepatic and reperfusion phases, a sudden and significant decrease in NT was observed in both groups. This decrease in NT was significantly greater in GII than GI. In conclusion, a sudden decrease in core temperature was observed during the anhepatic and reperfusion phases of LDLT in pediatric patients, likely caused by placement of the cold liver graft, which is flushed with 4°C lactated Ringer's solution during vessel reconstruction, in the anhepatic phase and return of venous blood through the cold preserved liver in the reperfusion phase. Core temperatures of pediatric patients with a body weight less than 10 kg in GII, who received grafts with a high GRWR, were more affected than those in GI. (Liver Transpl 2003;9:760-763.)

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

“…The information for each patient was anonymized and deidentified before analysis. The general anesthesia, intraoperative monitoring and blood transfusion protocols used [9] , as well as their documentation [10] , were similar to those described in previously published reports [5,9,[11][12][13] . Estimated blood losses were made through visual estimations of a small (250 mL) suction bottle (Receptal ® Accurate Measurement Device, Hospira, Inc. Lake Forest, Il 60045, United States) and the weight of laparotomy sponges.…”

“…The outcomes of such transplants for pediatric patients weighing less than 10 kg differ from those for pediatric patients weighing more than 10 kg [1][2][3][4] . We have previously reported that the average change in core temperature during an LDLT for pediatric patients weighing less than 10 kg is significantly different from that in heavier children [5] . Furthermore, a lower survival rate for lower weight children was reported by Arnon et al [3] , and according to other studies, this poorer survival results from higher risks of perioperative vascular complications, bile duct complications and infections [4,6,7] .…”

Maintenance of normothermia at operation room temperature of 24 oC in adult and pediatric patients undergoing liver transplantation

“…Although noted in both age groups, the sudden decrease in NT during the anhepatic and reperfusion phases has been found to correlate with GRWR only in pediatric patients [15]. Graft weight itself has no apparent correlation with NT in both adult and pediatric patients.…”

“…1 and Table 2). Further analysis showed that the degree of decrease in NT in children correlated with GRWR rather than the graft weight [15]. Although adult patients received heavier liver grafts, but the GRWR was significantly smaller when compared with that of the pediatric group (Table 1).…”

“…Regardless of operative site or anesthetic agent used, adult patients aged 20–85 years have been kept normothermic by maintaining OR temperature between 24 °C [13] and 26 °C [14]. Likewise, in pediatric living donor liver transplantation (LDLT) setting, keeping the OR temperature at 24 °C together with other active and passive warming measures allows maintenance of normothermia except in the anhepatic and reperfusion phase, a sudden decrease in nasopharyngeal temperature (NT) was observed [15], which was found to be related to the ratio of the cold preserved graft weight over recipient body weight (GRWR) rather than the graft weight itself [15]. No such mechanism has been proposed for adult patients.…”