Impact of Liver Ex Situ Transection on Pediatric Liver Transplantation

Netto, Alcides Augusto Salzedas; Amadei, H.L.; Castro, Christian; Mattar, R.; Medeiros, Kaelen L.; Linhares, Marcelo Moura; Duarte, Adriana Maria; Chinen, E.S.; Marino, Gustavo; Matos, Carla; Lopes-Filho, Gaspar Jesus; Martins, José Luiz; Gonzalez, A.M.

doi:10.1016/j.transproceed.2010.01.040

Cited by 6 publications

(5 citation statements)

References 7 publications

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“…Most reported studies have compared whole to partial liver grafts: In doing so, grafts with almost no risk of bleeding (like living‐related grafts) are pooled with grafts whose biological hemostasis has not been done (like ex situ split grafts). Therefore, studies on the impact of partial graft on intra‐operative bleeding show conflicting results . In our series, the graft was an ex situ split graft in 62% of cases, and an (ex situ) reduced graft in 5% of cases, resulting in 67% of potentially hemorrhagic grafts.…”

Section: Discussionmentioning

confidence: 76%

Preoperative risk factors for intra‐operative bleeding in pediatric liver transplantation

Fanna

Baptiste

Capito

et al. 2016

Pediatric Transplantation

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This study analyzes the preoperative risk factors for intra-operative bleeding in our recent series of pediatric LTs. Between November 2009 and November 2014, 84 consecutive isolated pediatric LTs were performed in 81 children. Potential preoperative predictive factors for bleeding, amount of intra-operative transfusions, postoperative course, and outcome were recorded. Cutoff point for intra-operative HBL was defined as intra-operative RBC transfusions ≥1 TBV. Twenty-six patients (31%) had intra-operative HBL. One-year patient survival after LT was 66.7% (CI 95%=[50.2-88.5]) in HBL patients and 83.8% (CI 95%=[74.6-94.1]) in the others (P=.054). Among 13 potential preoperative risk factors, three of them were identified as independent predictors of high intra-operative bleeding: abdominal surgical procedure(s) prior to LT, factor V level ≤30% before transplantation, and ex situ parenchymal transsection of the liver graft. Based on these findings, we propose a simple score to predict the individual hemorrhagic risk related to each patient and graft association. This score may help to better anticipate intra-operative bleeding and improve patient's management.

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Section: Discussionmentioning

confidence: 76%

Preoperative risk factors for intra‐operative bleeding in pediatric liver transplantation

Fanna

Baptiste

Capito

et al. 2016

Pediatric Transplantation

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“…Grafts with liver segments II and III are transplanted into pediatric recipients, while those with segments I and IV-VIII are transplanted into adult ones ( Figure 1). According to the current literature, the split technique has good results, with survival rates similar to those obtained with whole graft transplants 6,7,12,16,17 . However, conducted from September 2009 to April 2016 including pediatric patients undergoing splitliver transplantation at Hospital São Paulo, UNIFESP.…”

Section: ■ Introductionmentioning

confidence: 70%

“…the split technique may be associated with complications such as increased bleeding in the wound area, greater requirement of red blood cell transfusion, and occurrence of biliary leak 12,[16][17][18] .…”

Section: IIImentioning

confidence: 99%

Use of fibrinogen and thrombin sponge in pediatric split liver transplantation

et al. 2017

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Purpose: To analyze the use of this sponge in pediatric patients undergoing split-liver transplantation. Methods: Retrospective study, including 35 pediatric patients undergoing split-liver transplantation, divided into two groups according to the use of the sponge: 18 patients in Group A (no sponge) and 17 in Group B (with sponge). Results: The characteristics of recipients and donors were similar. We observed greater number of reoperation due to bleeding in the wound area in Group A (10 patients -55.5%) than in Group B (3 patients -17.6%); p = 0.035. The median volume of red blood cells transfused in Group A was significantly higher (73.4 ± 102.38 mL/kg) than that in Group B (35.1 ± 41.67 mL/kg); p = 0.048. Regarding bile leak there was no statistical difference. Conclusion: The use of the human fibrinogen and thrombin sponge, required lower volume of red blood cell transfusion and presented lower reoperation rates due to bleeding in the wound area.

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“…Currently, the ex-situ liver transection technique achieves good results in the literature, with survival rates similar to the results of transplants with whole graft 13 , 20 , 23 , 24 , 30 , but its use is not free of complications such as increased bleeding of the wound area of the graft, with greater use of blood products and biliary leak 14 , 23 , 30 , 36 .…”

Section: Introductionmentioning

confidence: 99%

“…When talking about liver transplantation with ex-situ liver transection, these are two possible procedures: hepatic reduction or split 17 , 26 , 30 .…”

Section: Introductionmentioning

confidence: 99%

Pediatric Liver Transplantation With Ex-Situ Liver Transection and the Application of the Human Fibrinogen and Thrombin Sponge in the Wound Area

Vicentine¹,

Gonzalez

Azevedo³

et al. 2016

ABCD, arq. bras. cir. dig.

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Background: Surgical strategy to increase the number of liver transplants in the pediatric population is the ex-situ liver transection (reduction or split). However, it is associated with complications such as hemorrhage and leaks. The human fibrinogen and thrombin sponge is useful for improving hemostasis in liver surgery. Aim: Compare pediatric liver transplants with ex-situ liver transection (reduction or split) with or without the human fibrinogen and thrombin sponge. Methods: Was performed a prospective analysis of 21 patients submitted to liver transplantation with ex-situ liver transection with the application of the human fibrinogen and thrombin sponge in the wound area (group A) and retrospective analysis of 59 patients without the sponge (group B). Results: The characteristics of recipients and donors were similar. There were fewer reoperations due to bleeding in the wound area in group A (14.2%) compared to group B (41.7%, p=0.029). There was no difference in relation to the biliary leak (group A: 17.6%, group B: 5.1%, p=0.14). Conclusion: There was a lower number of reoperations due to bleeding of the wound area of the hepatic graft when the human fibrinogen and thrombin sponge were used.

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Impact of Liver Ex Situ Transection on Pediatric Liver Transplantation

Cited by 6 publications

References 7 publications

Preoperative risk factors for intra‐operative bleeding in pediatric liver transplantation

Preoperative risk factors for intra‐operative bleeding in pediatric liver transplantation

Use of fibrinogen and thrombin sponge in pediatric split liver transplantation

Pediatric Liver Transplantation With Ex-Situ Liver Transection and the Application of the Human Fibrinogen and Thrombin Sponge in the Wound Area

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