Liver transplantation in infants with biliary atresia: comparison of primary versus temporary abdominal closure

Schukfeh, Nagoud; Holland, Anna-Charlotte; Hoyer, Dieter P.; Gallinat, Anja; Paul, Andreas; Schulze, Maren

doi:10.1007/s00423-016-1525-x

Cited by 9 publications

(11 citation statements)

References 17 publications

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“…Additionally, graft volume should be well‐matched to the recipient's abdomen size to prevent impairment of blood supply and graft dysfunction associated with abdominal compartment syndrome . Surgeons perform TAC with patch enlargement of the abdominal cavity when split adult‐liver grafts are too large to fit within the abdominal cavity of small patients without leading to pressurization of the organ . TAC was applied in 78% of children with a mean time until final abdominal closure (Table ) consistent with times in previously published case series .…”

Section: Discussionmentioning

confidence: 54%

“…Surgeons perform TAC with patch enlargement of the abdominal cavity when split adult‐liver grafts are too large to fit within the abdominal cavity of small patients without leading to pressurization of the organ . TAC was applied in 78% of children with a mean time until final abdominal closure (Table ) consistent with times in previously published case series . The decision on the use and size of a TAC patch was based on surgeons' clinical experience and repetitive US measurements during abdominal wall closure.…”

Section: Discussionmentioning

confidence: 96%

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Monitoring intra‐abdominal pressure after liver transplantation in children

Deindl

Wagner

Herden

et al. 2019

Pediatric Transplantation

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IAH after LTX can impair perfusion and threaten graft viability. This study aimed to assess the feasibility of longitudinal IAP measurements as an IAH screening method in children after LTX. A cohort of 23 children with a mean age (range) 3.1 (3 months–14 years) who underwent LTX between May 2017 and February 2018 were evaluated retrospectively. Longitudinal IAP measurements were compared to bedside Doppler US monitoring data. In total, 425 IAP measurements and 257 US examinations were performed. The mean ± SD (range) time expenditure for IAP measurement was 1.9 ± 0.4 (0.5‐3.2) minutes. The mean post‐operative IAP was 7.9 ± 3.6 (1‐25) mm Hg. IAH (IAP ≥ 10 mm Hg) was noted in 102 (24%) of 257 measurements. Agitation had a significant impact on IAP (estimate: 9.3 mm Hg, CI: 6.72‐11.97, P < .01). In patients with TAC, IAP was increased (6.7 ± 2.1 vs 8.7 ± 3.1 mm Hg, P = .02) while peak portal venous velocities decreased (38 ± 27 vs 26 ± 22 cm/s, P = .03) after patch reduction. An abdominal compartment syndrome with severely impaired vascular flow was noted in one patient. Episodes of elevated IAP were noted in a large proportion of patients, underscoring the need for IAP monitoring in pediatric liver transplant recipients. The safety and low time expenditure associated with IAP measurement could be included easily into standard nursing procedures for these patients.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 96%

Monitoring intra‐abdominal pressure after liver transplantation in children

Deindl

Wagner

Herden

et al. 2019

Pediatric Transplantation

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“…Significant variation exists between centers in patient selection, patient age and size, graft selection, as well as surgical techniques and experience, which all impact greatly on the development of thrombosis. This is most notably demonstrated in the population of infants ≤10 kg with the highest reported rates of thrombosis of the cohort (HAT and PVT incidence of 28% and 41%, respectively) . The impact of these and other factors on the incidence of thrombosis has been discussed in previous articles .…”

Section: Discussionmentioning

confidence: 91%

Antithrombotic management and thrombosis rates in children post–liver transplantation: A case series and literature review

Flynn

Huang

Hardikar

et al. 2019

Pediatric Transplantation

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Thrombosis is a major postoperative complication in pediatric liver transplantation. There is marked heterogeneity in prophylactic antithrombotic therapies used, without established guidelines. This review summarizes current worldwide incidence of thrombotic events and compares antithrombotic therapies in children post–liver transplant, with comparison to our institution's experience. Of the twenty‐three articles with sufficient detail to compare antithrombotic regimens, the overall incidence of thrombosis ranged from 2.4% to 17.3%. Incidence of HAT ranged from 0% to 28.1%, of HVT from 0% to 4.7%, of PVT from 1.5% to 11.2%, and of IVC thrombosis from 0% to 2.8%. Re‐transplantation due to thrombosis ranged from 0% to 4.8%. Prophylactic antithrombotic therapies varied between studies, and bleeding complications were infrequently reported. Since 2010, 96 children underwent 100 liver transplants at our institution with thrombosis incidence comparable to international literature (HAT 6%, PVT 5%, IVC 1%, and HVT 0%). Re‐transplantation due to thrombosis occurred in 2% and major bleeding occurred in 10%. The prophylactic antithrombotic therapies used post–liver transplantation in children remain varied. Low rates of thrombosis have been reported with antiplatelet use both with and without anticoagulation. Standard definitions and consistent reporting of bleeding complications are required, in addition to thrombosis rates, so that true risk‐benefit assessment of reported regimes can be understood.

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“…Statistical analysis was performed using SPSS software (v21, SPSS Inc., Chicago, IL) and the platform VassarStats. (24)…”

Section: Discussionmentioning

confidence: 99%

“…Two‐tailed P values less than 0.05 were considered statistically significant. Statistical analysis was performed using SPSS software (v21, SPSS Inc., Chicago, IL) and the platform VassarStats …”

Section: Methodsmentioning

confidence: 99%

Clinical Outcome and Viral Genome Variability of Hepatitis B Virus–Induced Acute Liver Failure

et al. 2019

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Liver transplantation in infants with biliary atresia: comparison of primary versus temporary abdominal closure

Abstract: In our study, primary abdominal closure displays a similar outcome in comparison to temporary abdominal closure.

Cited by 9 publications

References 17 publications

Monitoring intra‐abdominal pressure after liver transplantation in children

Monitoring intra‐abdominal pressure after liver transplantation in children

Antithrombotic management and thrombosis rates in children post–liver transplantation: A case series and literature review

Clinical Outcome and Viral Genome Variability of Hepatitis B Virus–Induced Acute Liver Failure

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