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

Miura, Kiyonori; Sakamoto, Seisuke; Shimata, Keita; Honda, Masaki; Kobayashi, Takashi; Wakai, Toshifumi; Sugawara, Yasuhiko; Inomata, Yukihiro

doi:10.1007/s00595-017-1533-7

Cited by 11 publications

(13 citation statements)

References 25 publications

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“…National and international registries could potentially provide meaningful data by allowing for a risk-benefit analysis of laparoscopic procedures for pediatric liver transplantation. Well-organized papers that discuss the technique have been published from various centers (17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

Long‐Term Safety and Efficacy of Pure Laparoscopic Donor Hepatectomy in Pediatric Living Donor Liver Transplantation

Kim

Cho

et al. 2020

Liver Transpl.

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Background: Laparoscopic living-donor hepatectomy for transplantation has been established well over the last decade. This study aimed to assess its safety and feasibility in pediatric living-donor liver transplantation (LDLT) by comparing the surgical and longterm survival outcomes on both the donor and recipient sides between open and laparoscopic groups. Methods: The medical records of 100 patients (≤17 years old) who underwent ABOcompatible LDLT using a left lateral liver graft between May 2008 and June 2016 were analyzed. Thirty-one donors who underwent pure laparoscopic hepatectomy and their corresponding recipients were included in the study. Sixty-nine patients who underwent open living-donor hepatectomy during the same period were included as a comparison group. To overcome bias from the different distributions of covariables among the patients in the two study groups, a 1:1 propensity score matching analysis was performed. Results: The mean follow-up periods were 92.9 and 92.7 months in the open and laparoscopic groups, respectively. The mean postoperative hospital stay of the donors was significantly shorter in the laparoscopic group (8.1 days) than in the open group (10.6 days; p<0.001). Overall, the surgical complications in the donors and overall survival rate of recipients did not differ between the groups. Conclusion: Our data suggests that the laparoscopic environment was not associated with long-term graft survival during pediatric LDLT. In addition, the laparoscopic approach for the donors did not adversely affect the corresponding recipient's outcome. Laparoscopic left lateral sectionectomy for living donors is a safe, feasible, and reproducible procedure for pediatric liver transplantation.

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Section: Discussionmentioning

confidence: 99%

Long‐Term Safety and Efficacy of Pure Laparoscopic Donor Hepatectomy in Pediatric Living Donor Liver Transplantation

Kim

Cho

et al. 2020

Liver Transpl.

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“…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%

“…Lastly, patients with a MELD/PELD score of <15 have the best chances of survival, regardless of the need for life support. (1,6,8,17,26,27) Finally, we report a group of patients who were relisted for eRe-LT but recovered without an LT and retained their graft. Some of whom underwent later re-LT, and others permanently retained their first graft.…”

Section: Original Articlementioning

confidence: 98%

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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“…15 Studies have shown that repeat grafts demonstrate decreasing survival rates with each subsequent graft. 28,29 Overall, clinical outcomes of retransplanted recipients are less favorable than those of patients who have retained their primary graft. 16,17,28,29 Evidence also suggests a significantly higher risk of death for retransplanted patients during the first month posttransplant relative to patients on dialysis.…”

Section: Physicians' Responsibilitiesmentioning

confidence: 99%

“…28,29 Overall, clinical outcomes of retransplanted recipients are less favorable than those of patients who have retained their primary graft. 16,17,28,29 Evidence also suggests a significantly higher risk of death for retransplanted patients during the first month posttransplant relative to patients on dialysis. 28,30,31 Furthermore, opponents believe that physicians should be parsimonious in their provision of care when operating under circumstances of limited resources and try to minimize unnecessary costs.…”

Section: Physicians' Responsibilitiesmentioning

confidence: 99%

Is Organ Retransplantation Among Undocumented Immigrants in the United States Just?

Ackah

Sigireddi

Murthy

2019

AMA Journal of Ethics

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

Cited by 11 publications

References 25 publications

Long‐Term Safety and Efficacy of Pure Laparoscopic Donor Hepatectomy in Pediatric Living Donor Liver Transplantation

Long‐Term Safety and Efficacy of Pure Laparoscopic Donor Hepatectomy in Pediatric Living Donor Liver Transplantation

Prognostic Factors in Pediatric Early Liver Retransplantation

Is Organ Retransplantation Among Undocumented Immigrants in the United States Just?

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