Decreased Incidence of Hepatic Artery Thrombosis in Pediatric Liver Transplantation Using Technical Variant Grafts: Report of the Society of Pediatric Liver Transplantation Experience

Ebel, Noelle H.; Hsu, Evelyn; Dick, A.; Shaffer, Michele L.; Carlin, Kristen; Horslen, Simon

doi:10.1016/j.jpeds.2020.06.053

Cited by 27 publications

(44 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Ebel et al performed a study using multicenter data from the Society of Pediatric Liver Transplantation (SPLIT) database to evaluate the predictors of HAT. In contrast to previous publications, the authors found a decreased risk of HAT in recipients of split, reduced, or living donor grafts compared to whole grafts (OR 0.59, p < 0.001) ( 24 ). Furthermore, a study by Alexopoulos et al in pediatric patients ≤7 kg undergoing liver transplant for biliary atresia showed a lower incidence of vascular thrombosis in the technical variant patients than in whole liver recipients (LD (6%) and deceased donor partial liver grafts (5%) compared with whole grafts (13%); p < 0.002) ( 25 ).…”

Section: Discussioncontrasting

confidence: 69%

Living Donor Liver Transplantation vs. Split Liver Transplantation Using Left Lateral Segment Grafts in Pediatric Recipients: An Analysis of the UNOS Database

Dalzell¹,

Vargas²,

Soltys³

et al. 2022

Transpl Int

View full text Add to dashboard Cite

Split and LDLT in pediatric patients have the potential to decrease wait times and waitlist mortality. Using UNOS-STAR data, we compared outcomes of pediatric patients undergoing LDLT and SLT using LLS grafts. The baseline characteristics and post-operative outcomes were compared between groups. Actuarial graft and patient survival were analyzed with Kaplan-Meier curves. Between 2010 and 2019, 911 pediatric LT were included in the analysis (LD graft group, n = 508, split graft group, n = 403). LD graft recipients spent more time on the waitlist vs. the split graft group (60 (22–138) days vs. 46 (16–108) days; p = 0.007). LD recipients had a lower rate of graft failure, found in 9.8% of patients compared with 14.6% in the split graft group (p = 0.02). HAT was the most common graft failure cause, with similar rates. Graft and patient survival at 1-, 3-, and 5-years was comparable between LDLT and SLT. In subgroup analyses, patients with biliary atresia, those ≤10 kg or ≤10 years old receiving an LD graft showed improved graft survival. In conclusion, LDLT is associated with a lower rate of graft failure in pediatric patients. The use of LLS regardless of the type of donor is a safe way to facilitate access to transplantation to pediatric patients with acceptable short and long-term outcomes.

show abstract

Section: Discussioncontrasting

confidence: 69%

Living Donor Liver Transplantation vs. Split Liver Transplantation Using Left Lateral Segment Grafts in Pediatric Recipients: An Analysis of the UNOS Database

Dalzell¹,

Vargas²,

Soltys³

et al. 2022

Transpl Int

View full text Add to dashboard Cite

show abstract

“…We noted that the most common cause of death post first transplant was respiratory failure when categorized for age or weight, which was followed by hepatic artery thrombosis. However, no differences in ischemia times, portal vein thrombosis, postoperative portal stenosis or hepatic artery stenosis were noted among the age or weight groups, which is important as it highlights significant advancement in surgical techniques over the past few decades 15,49‐51 . In order to make specific recommendations regarding preventative measures for each cause of death would require much more detail on risk factors in each case that are not captured by the SPLIT database.…”

Section: Discussionmentioning

confidence: 99%

Outcomes following liver transplantation in young infants: Data from the SPLIT registry

Jain

Anand

Lerret

et al. 2021

American Journal of Transplantation

View full text Add to dashboard Cite

Liver transplantation (LT) in young patients is being performed with greater frequency. We hypothesized that objective analysis of pre‐, intra‐, and postoperative events would help understand contributors to successful outcomes and guide transplant decision processes. We queried SPLIT registry for pediatric transplants between 2011 and 2018. Outcomes were compared for age groups: 0‐<3, 3‐<6, 6‐<12 months, and 1‐<3 years (Groups A, B, C, D respectively) and by weight categories: <5, 5‐10, >10 kg; 1033 patients were available for analysis. Cholestatic disease and fulminant failure were highest in group A and those <5 kg; and biliary atresia in group C (72.8%). Group A had significantly higher life support dependence (34.6%; P < .001), listing as United Network for Organ Sharing status 1a/1b (70.4%; P < .001), and shortest wait times (P < .001). The median (interquartile range) for international normalized ratio and bilirubin were highest in group A (3.0 [2.1‐3.9] and 16.7 [6.8‐29.7] mg/dL) and those <5 kg (2.6 [1.8‐3.4] and 13.5 [3.0‐28.4] mg/dL). A pediatric end ‐stage liver disease score ≥40, postoperative hospital stays, rejection, and nonanastomotic biliary strictures were highest in group A with lowest survival at 93.1%. Infants 0 to <3 months and those <5 kg need more intensive care with lower survival and higher complications. Importantly, potential LT before reaching status 1a/1b and aggressive postoperative management may positively influence their outcomes.

show abstract

“…AT is the most deadly complication of LT, since it compromises immediate and deferred graft viability -due to parenchymal necrosis in the first case, and to ischemic cholangiopathy in the second, given that the biliary tree entirely relies on arterial vascularization. Risk is maximum in the first two weeks, with an estimated incidence of 6% -this number varies widely according to institutions and eras (27) . Post-transplantation thrombotic events, regardless of the vessel involved (arterial, portal or hepatic vein thrombosis), range from 2.4% to 17.3% (28) .…”

Section: Greater Risk Of Thrombosismentioning

confidence: 99%

Pediatric liver transplantation

2022

View full text Add to dashboard Cite

Decreased Incidence of Hepatic Artery Thrombosis in Pediatric Liver Transplantation Using Technical Variant Grafts: Report of the Society of Pediatric Liver Transplantation Experience

Cited by 27 publications

References 25 publications

Living Donor Liver Transplantation vs. Split Liver Transplantation Using Left Lateral Segment Grafts in Pediatric Recipients: An Analysis of the UNOS Database

Living Donor Liver Transplantation vs. Split Liver Transplantation Using Left Lateral Segment Grafts in Pediatric Recipients: An Analysis of the UNOS Database

Outcomes following liver transplantation in young infants: Data from the SPLIT registry

Pediatric liver transplantation

Contact Info

Product

Resources

About