Comparative results of reduced-size and whole liver transplantation in small children

Jara, Paloma; Díaz, María Eugenia López-Jacoiste; Camarena, C.; Vega, A. de la; Santamarı́a, Manuel; Murcia, J; Larrauri, J; Sánchez-Peinado, Carmen; Prieto, C; Zafra, M.; Gámez, M

doi:10.1016/s0041-1345(96)00176-5

Cited by 6 publications

(7 citation statements)

References 5 publications

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“…Use of reduced‐size instead of whole liver grafts has been reported to reduce the incidence of HAT, in children < 5‐yr old, from 25 to 4% ( 2, 13), although Jara et al. ( 12) found no statistical difference in a prospective series of 31 children < 3‐yr old. The type of arterial inflow may also influence the occurrence of HAT.…”

Section: Discussionmentioning

confidence: 99%

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Hepatic artery thrombosis in pediatric liver transplantation: Graft salvage after thrombectomy

García-Gallont¹,

Bar-Nathan

Shaharabani

et al. 1999

Pediatric Transplantation

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Hepatic artery thrombosis (HAT) is a devastating complication that may occur after orthotopic liver transplantation (OLT). A higher incidence has been reported in children. Salvage of the graft by thrombectomy has been suggested as an alternative to re-transplantation. In this study we report the outcome of three children who underwent thrombectomy for HAT. Between January 1992 and June 1998, 14 children (< 17 yrs of age) underwent liver transplantation. Three developed HAT (one a whole-liver graft recipient, age 17; two living-related graft recipients, ages 4 and 4.5 yr). In the first patient, thrombosis of the hepatic artery was associated with scattered areas of parenchymal necrosis on computed tomography. In the two living-related patients, HAT was found incidentally during re-exploration for bleeding (day 2 and day 10). Thrombectomy was performed in all three patients. At 18-24 months after thrombectomy, all three children had normal graft function. In the first patient, complete regeneration of the liver has been documented by computed tomography and a late asymptomatic recurrent thrombosis is suggested by absence of arterial flow on Doppler examination. The hepatic artery is patent in the two living-related recipients. One of these living-related recipients developed ischemic bile duct stricture and underwent successful percutaneous balloon dilatation. We conclude that long-term normal graft function can be achieved by thrombectomy in pediatric liver recipients with HAT, even in the presence of limited parenchymal damage.

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Section: Discussionmentioning

confidence: 99%

“…Hepatic artery thrombosis may constitute a catastrophic event after OLT, potentially leading to the need for urgent re‐transplantation or even to the patient’s death ( 4, 5, 8, 12). The incidence of HAT is higher in children and varies in accordance with a number of recognized risk factors and surgical techniques ( Table 1) ( 1–6).…”

Section: Discussionmentioning

confidence: 99%

Hepatic artery thrombosis in pediatric liver transplantation: Graft salvage after thrombectomy

García-Gallont¹,

Bar-Nathan

Shaharabani

et al. 1999

Pediatric Transplantation

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“…If denying is advisable in patients for whom the immediate prognosis is not engaged, the choice is more complex for severe patients. Graft reduction is an attractive solution, commonly achieved in pediatric LT . However, its feasibility in severe patients remains uncertain.…”

Section: Discussionmentioning

confidence: 99%

Extreme large‐for‐size syndrome after adult liver transplantation: A model for predicting a potentially lethal complication

et al. 2017

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There is currently no tool available to predict extreme large-for-size (LFS) syndrome, a potentially disastrous complication after adult liver transplantation (LT). We aimed to identify the risk factors for extreme LFS and to build a simple predictive model. A cohort of consecutive patients who underwent LT with full grafts in a single institution was studied. The extreme LFS was defined by the impossibility to achieve direct fascial closure, even after delayed management, associated with early allograft dysfunction or nonfunction. Computed tomography scan-based measurements of the recipient were done at the lower extremity of the xiphoid. After 424 LTs for 394 patients, extreme LFS occurred in 10 (2.4%) cases. The 90-day mortality after extreme LFS was 40.0% versus 6.5% in other patients (P = 0.003). In the extreme LFS group, the male donor-female recipient combination was more often observed (80.0% versus 17.4%; P < 0.001). The graft weight (GW)/right anteroposterior (RAP) distance ratio was predictive of extreme LFS with the highest area under the curve (area under the curve, 0.95). The optimal cutoff was 100 (sensitivity, 100%; specificity, 88%). The other ratios based on height, weight, body mass index, body surface area, and standard liver volume exhibited lower predictive performance. The final multivariate model included the male donor-female recipient combination and the GW/RAP. When the GW to RAP ratio increases from 80, 100, to 120, the probability of extreme LFS was 2.6%, 9.6%, and 29.1% in the male donor-female recipient combination, and <1%, 1.2%, and 4.5% in other combinations. In conclusion, the GW/RAP ratio predicts extreme LFS and may be helpful to avoid futile refusal for morphological reasons or to anticipate situation at risk, especially in female recipients. Liver Transplantation 23 1294-1304 2017 AASLD.

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“…Thus, the increased complexity of the technique for graft reduction and consequently a prolonged cold ischemic time during the entire procedure would increase the rate of graft-related complications and possibly graft loss. However, recent advances in the reduction technique, organ preservation, and immunosuppressive treatment have improved the results for the technical-variant grafts [6, 8]. Because of this, the use of a reduced-size graft may no longer pose a risk for graft loss in an experienced center.…”

Section: Discussionmentioning

confidence: 99%

“…In early experiences, the technical-variant grafts from cadavers were found to be more likely to fail due to graft-related complications compared to the whole grafts [5,6,7]. Recently, reduced-liver grafts have been shown to have comparable results with those of size-matched whole grafts [1, 8]. Advances in the field of organ procurement, surgical techniques, perioperative management, and immunosuppression might have contributed to these better outcomes.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Graft Outcome of Pediatric Liver Transplantation in Copenhagen: Analysis of the First 51 Cases

Yamauchi¹,

Yamashita²,

Wettergren³

et al. 2006

Dig Surg

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Background: Graft loss after liver transplantation remains a significant problem, especially in pediatric patients. The aim of this study was to assess our initial series of pediatric liver transplantation and to identify the risk factors that influence graft outcome. Methods: The first 51 transplantations were analyzed retrospectively. All transplantations were stratified into three groups according to graft type (full-size, reduced-size, and living-related-donor graft). Survival data of the grafts were stratified and multivariate analysis conducted with respect to preoperative and surgical factors. Results: Seventeen of all the transplants were full-size grafts and 34 technical-variant grafts (27 reduced-size grafts from cadavers and 7 living-related-donor grafts). The overall graft survival rates were 65, 62 and 53% at 1, 3 and 5 years, respectively. Twenty-three of 51 grafts (45%) were lost. Poor status of the recipients (hospitalization or intensive care unit care before surgery), a retransplanted graft, and a reduced-size graft were independent risk factors for graft failure. With experience, overall graft survival has improved significantly and the differences in graft survival between graft types have disappeared. Conclusions: To improve graft survival after pediatric liver transplantation, the timely referral of potential recipients to the transplant team and employing a meticulous technique during the operation, particularly for the technical-variant graft, are required.

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Comparative results of reduced-size and whole liver transplantation in small children

Cited by 6 publications

References 5 publications

Hepatic artery thrombosis in pediatric liver transplantation: Graft salvage after thrombectomy

Hepatic artery thrombosis in pediatric liver transplantation: Graft salvage after thrombectomy

Extreme large‐for‐size syndrome after adult liver transplantation: A model for predicting a potentially lethal complication

Long-Term Graft Outcome of Pediatric Liver Transplantation in Copenhagen: Analysis of the First 51 Cases

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