#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Liver Transplantations in Children Using Reduced Grafts


Authors: M. Oliverius;  L. Janoušek;  M. Adamec;  M. Kučera;  M. Ryska 1;  F. Bělina 1;  J. Šnajdauf 2;  M. Rygl 2;  M. Prchlík 3;  R. Kotalová 4;  O. Hyánková 5;  Z. Mixa 6;  P. Trunečka 7
Authors‘ workplace: Klinika transplantační chirurgie IKEM, Praha, přednosta: prof. MUDr. Miloš Adamec, CSc. ;  Chirurgická klinika 2. LF UK a ÚVN, Praha, přednosta: prof. MUDr. Miroslav Ryska, CSc. 1;  Oddělení dětské chirurgie Fakultní nemocnice Motol, Praha, přednosta: prof. MUDr. Jiří Šnajdauf, CSc. 2;  Klinika dětské chirurgie a traumatologie 3. LF UK, FTNsP, Praha, přednosta: prof. MUDr. Petr Havránek, CSc. 3;  Pediatrická klinika UK 2. LF a FN Motol, přednosta: prof. MUDr. Jan Lebl, CSc. 4;  Klinika anestesie a resuscitace IKEM, Praha, přednostka: MUDr. Eva Kieslichová 5;  Klinika anesteziologie a resuscitace UK 2. LF a FN Motol (KAR) přednosta: prof. MUDr. Karel Cvachovec, CSc., MBA 6;  Klinika hepatologie IKEM, Praha, přednosta: prof. MUDr. Julius Špičák, CSc. 7
Published in: Rozhl. Chir., 2010, roč. 89, č. 7, s. 411-416.
Category: Monothematic special - Original

Overview

Aim:
Liver transplantation is a life- saving procedure in patients with end stage liver disease. Five-year survival in patients indicated for transplantation based on standard indication criteria, has reached a rate over 80%. Shortage of suitable grafts remains the main problem in these procedures. While the situation in adult patients is relatively satisfactory, liver transplantations in children, mainly in the low-weight categories, remain a worldwide problem because of the absolute lack of suitable donors. In order to reduce mortality in the youngest patients on the waiting list, a concept of reduction of the adult graft for pediatric use was introduced in the early 1990s. Recent introduction of novel methods, such as split transplantations or transplantations between relatives, has resulted in lower mortality rates in the youngest recipients on the waiting lists. The author assesses a group of patients below 18 years of age, who underwent reduced liver graft transplantations in the Czech Republic.

Material and Methods:
From 1995 to 2009, a total of 43 patients below 18 years of age underwent transplantations, using 48 liver grafts. Further 17 children were sent abroad for transplantations, where a total of 23 liver grafts were used. Only patients who underwent transplantations using the liver grafts adjusted in IKEM were assessed in the patient group, i.e. 14 patients, resp. 16 liver grafts. Reduction was performed in 13 subjects. One subjects underwent transplantation between relatives and a liver split was used in two subjects. In the lowest weight category up to 10 kgs, 5 liver reductions were performed.

Outcomes:
Out of the total (n = 16), 4 grafts failed (2 were early postoperative failures, ie. within 2 postoperative days and 2 grafts failed in Month 5). The mean graft survival was 65 months. Within the youngest recipient age group (n = 5), no graft failure was recorded. The mean survival time is 26 months.

Conclusion:
Since 2007, the Czech Republic has been providing a program for all patients, including the lowest weight-category pediatric patients. To date data are satisfactory. No graft failure has been recorded in the category of the smallest (up to 10 kgs) pediatric patients.

Key words:
liver transplantation – reduced graft – split transplantation – transplantation between relatives – end stage liver disease – pediatric transplantations


Sources

1. Broelsch, C. E., Emond, J. C., Whitington, P. F., Thistlethwaite, J. R., Baker, A. L., Lichtor, J. L. Application of reduced-size liver transplants as split grafts, auxiliary orthotopic grafts, and living related segmental transplants. Ann. Surg., 1990, Sep; 212(3): 368–375; discussion 75–77.

2. Emond, J. C., Whitington, P. F., Thistlethwaite, J. R., Cherqui, D., Alfonso, E. A., Woodle, I. S., et al. Transplantation of two patients with one liver. Analysis of a preliminary experience with lit-liver rafting. Ann. Surg., 1990, Jul; 212(1): 14–22.

3. Busuttil, R. W., Colonna, J. O. 2nd, Hiatt, J. R., Brems, J. J., el Khoury, G., Goldstein, L. I., et al. The first 100 liver transplants at UCLA. Ann. Surg., 1987, Oct; 206(4): 387–402.

4. Bismuth, H., Houssin, D. Reduced-sized orthotopic liver graft in hepatic transplantation in children. Surgery, 1984, Mar; 95(3): 367–370.

5. Broyer, M., Otte, J. B., Kachaner, J., Goulet, O. Organ transplantation in children. Intensive Care Med., 1989; 15 Suppl. 1: S76–79.

6. Otte, J. B., de Ville de Goyet, J., Sokal, E., Alberti, D., Moulin, D., de Hemptinne, B., et al. Size reduction of the donor liver is a safe way to alleviate the shortage of size-matched organs in pediatric liver transplantation. Ann. Surg., 1990, Feb; 211(2): 146–157.

7. Houssin, D., Soubrane, O., Boillot, O., Dousset, B., Ozier, Y., Devictor, D., et al. Orthotopic liver transplantation with a reduced-size graft: an ideal compromise in pediatrics? Surgery, 1992, May; 111(5): 532–542.

8. Couinaud, C. Contribution of anatomical research to liver surgery. Fr. Med., 1956, May; 19(5): 5–12.

9. Pichlmayr, R., Ringe, B., Gubernatis, G., Hauss, J., Bunzendahl, H. Transplantation of a donor liver to 2 recipients (splitting transplantation) – a new method in the further development of segmental liver transplantation. Langenbecks Arch. Chir., 1988; 373(2): 127–130.

10. Otte, J. B., de Ville de Goyet, J., Alberti, D., Balladur, P., de Hemptinne, B. The concept and technique of the split liver in clinical transplantation. Surgery, 1990, Jun; 107(6): 605–612.

11. Otte, J. B. Is it right to develop living related liver transplantation? Do reduced and split livers not suffice to cover the needs? Transpl. Int., 1995; 8(1): 69–73.

12. Koristek, V., Peresty, S., Cerny, J., Gregor, Z., Hokl, J., Hejl, F., et al. Clinical transplantation of the liver. Rozhl. Chir., 1983, May; 62(5): 372–374.

13. Ryska, M., Snajdauf, J., Belina, F., Mixa, Z., Kieslichova, E., Kalousova, J., et al. Living relative donor for liver transplantation in paediatric recipient. Cas. Lek. Cesk., 2005; 144(8): 560–565; discussion 565–566.

14. Česká transplantační společnost. Zemřelí dárci orgánů/ 1.mil. obyvatel ČR 1990–2006 [on line]. 2006-006-09 [cit.2010-103-01].Dostupný na WWW

15. McDiarmid, S. V. Risk factors and outcomes after pediatric liver transplantation. Liver Transpl. Surg., 1996 Sep; 2(5 Suppl 1): 44–56.

16. Duffy, J. P., Hong, J. C., Farmer, D. G., Ghobrial, R. M., Yersiz, H., Hiatt, J. R., et al. Vascular complications of orthotopic liver transplantation: experience in more than 4,200 patients. J. Am. Coll. Surg., 2009 May; 208(5): 896–903; discussion 905.

17. Mazzaferro, V., Esquivel, C. O., Makowka, L., Kahn, D., Belle, S., Scantlebury, V. P., et al. Factors responsible for hepatic artery thrombosis after pediatric liver transplantation. Transplant. Proc., 1989 Feb; 21(1 Pt 2): 2466–2467.

18. Heffron, T. G., Emond, J. C., Whitington, P. F., Thistlethwaite, J. R. Jr., Stevens, L., Piper, J., et al. Biliary complications in pediatric liver transplantation. A comparison of reduced-size and whole grafts. Transplantation, 1992, Feb; 53(2): 391–395.

19. Sieders, E., Peeters, P. M., TenVergert, E. M., Bijleveld, C. M., de Jong, K. P., Zwaveling, J. H., et al. Analysis of survival and morbidity after pediatric liver transplantation with full-size and technical-variant grafts. Transplantation, 1999, Aug 27; 68(4): 540–545.

20. Oswari, H., Lynch, S. V., Fawcett, J., Strong, R. W., Ee, L. C. Outcomes of split versus reduced-size grafts in pediatric liver transplantation. J. Gastroenterol. Hepatol., 2005, Dec; 20(12): 1850–1854.

Labels
Surgery Orthopaedics Trauma surgery

Article was published in

Perspectives in Surgery

Issue 7

2010 Issue 7

Most read in this issue
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#