A new pediatric liver transplantation program in Southern Germany. The Heidelberg experience

Abstract

pLTx is a highly complex procedure. It can only be performed safely by experienced teams. Starting a new pLTx program in a country with established centers must therefore avoid a learning curve. We have initiated a liver transplantation program for children in 2003. Medical standards were defined by a team of surgeons, pediatricians, radiologists, anesthesiologists, and pathologists before the first transplantation. An external expert in the field of pLTx supervised the whole process. In a pilot phase, six children weighing more than 20 kg were successfully transplanted. Following this series, the clinical pathways were re-evaluated, and the program was opened for children of all age groups. Between 2003 and 2008, 32 children received 34 organs. Sixty-eight percent of patients received a split-liver, 26% a full size organ, and 6% a reduced size graft. Four LRLTx were performed. Patient survival rate was 91%. We conclude that a new pLTx program can be established without a significant learning curve regarding mortality if a strict strategy of team-building is followed. In the pilot phase, small children and infants have to be referred and transplanted in an established center. An interdisciplinary team of specialists closely working together is the key for sustained success.

Technique advance to avoid hepatic venous outflow obstruction in pediatric living‐donor liver transplantation

“…With respect to HVOO, the incidence following pediatric liver transplantation has been increasing in clinical practice because classical whole‐liver transplantation has been replaced with reduced‐size cadaveric or living‐donor liver transplantation. In the current series (unpublished observation) and in other reported experiences, whole‐liver transplantations in children represent only 10–25% of all cases . Consequently, anastomotic stricture of the hepatic veins has been described as a serious complication in pediatric patients because of the reduced caliber of the hepatic veins compared with those of adults.…”

Growth of liver allografts over time in pediatric transplant recipients

“…Surgical technique was further developed to allow for the transplantation of partial‐liver grafts from deceased donor split livers and living donors . Younger prospective recipients are more likely to receive a partial allograft, with one center reporting up to 74% of pediatric liver transplants performed with partial grafts . Despite the use of reduced size livers, small pediatric patients often receive a liver that has excess mass compared to the metabolic need.…”

“…8 Younger prospective recipients are more likely to receive a partial allograft, with one center reporting up to 74% of pediatric liver transplants performed with partial grafts. 9,10 Despite the use of reduced size livers, small pediatric patients often receive a liver that has excess mass compared to the metabolic need. These large livers will atrophy in the early postoperative period and allow for the strategy of delayed abdominal closure.…”