Living Donor Liver Transplantation for Biliary Atresia: A Single-Center Experience with First 100 Cases

Chen, C.-L.; Concejero, Allan M.; Wang, C.-C.; Wang, S.-H.; Lin, Chih‐Che; Liu, Y.-W.; Yong, Chee‐Chien; Yang, Chien‐Hsin; Lin, Tsan‐Shiun; Chiang, Yuan‐Cheng; Jawan, Bruno; Huang, Tung‐Liang; Cheng, Yu‐Fan; Eng, Hock‐Liew

doi:10.1111/j.1600-6143.2006.01528.x

Cited by 106 publications

(79 citation statements)

References 37 publications

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“…We have previously reported that the average change in core temperature during an LDLT for pediatric patients weighing less than 10 kg is significantly different from that in heavier children [5] . Furthermore, a lower survival rate for lower weight children was reported by Arnon et al [3] , and according to other studies, this poorer survival results from higher risks of perioperative vascular complications, bile duct complications and infections [4,6,7] . In pediatric kidney transplantation, the ideal body weight for a recipient has also been found to be greater than 10 kg [8] .…”

Section: Introductionmentioning

confidence: 97%

Living donor liver transplantation with body-weight more or less than 10 kilograms

Yang

Huang

Chen

et al. 2015

WJG

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AIM:To compare the outcomes of pediatric patients weighing less than or more than 10 kg who underwent liver transplantation. METHODS: Data for 196 pediatric patients who underwent living donor liver transplantation betweenJune 1994 and February 2011 were reviewed retrospectively. The information for each patient was anonymized and de-identified before analysis. The data included information regarding the pre-transplant conditions, intraoperative fluid replacement and outcomes for each patient. The 196 patients were divided into two groups: those with body weights of less than 10 kg were included in group 1 (G1; n = 101), while those with body weights of more than 10 kg were included in group 2 (G2; n = 95). For each group, the patients' ages, body weights, heights, pediatric end stage liver disease scores, anesthesia times, and warm and cold ischemic times were analyzed. In addition, between-group comparisons were also made. Mann-Whitney U tests were used to compare all the variables except for complications and survival rates, which were analyzed using χ 2 tests and Kaplan-Meier tests, respectively. RESULTS:The general medical conditions of the G1 Retrospective StudyLiving donor liver transplantation with body-weight more or less than 10 kilograms patients were worse than those of the G2 patients, as shown by the higher pediatric end stage liver disease scores and poorer Z -scores. In addition, the preoperative Hb and serum albumin levels were all lower for the G1 patients than for the G2 patients. The G1 patients also had significantly more intraoperative blood loss than the G2 patients. In addition, the intraoperative fluid requirements for the G1 patients, including leukocyte poor red blood cell transfusions, 5% albumin infusions and crystalloid infusions, were significantly higher than those for the G2 patients. The risk of intraoperative portal vein thrombosis was higher for the patients in G1 than for those in G2. However, the one-year survival rates (95.9% and 96.8% for G1 and G2, respectively) and three-year survival rates (94.9% and 94.6% for G1 and G2, respectively) for both groups were similar. CONCLUSION:Patients weighing less than 10 kg typically have poorer conditions, but their survival rates are comparable to those of children weighing more than 10 kg. Core tip: Although pediatric patients weighing less than 10 kg who underwent living donor liver transplantation usually had worse pre-transplant conditions, more intraoperative bleeding and more portal vein complications, their three-year survival rate was 94%, a rate comparable to that achieved by children weighing more than 10 kg. A prerequisite for achieving these excellent results is good and effective teamwork. Cooperation between surgeons, plastic surgeons, and anesthesiologists in the operating theater is fundamental, but the contributions of radiologists are also critical. Radiologists should be available in the operating room to perform Doppler ultrasounds or place vascular stents, as required.Yang SC, Huang CJ, Chen CL, Wang CH,...

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Section: Introductionmentioning

confidence: 97%

Living donor liver transplantation with body-weight more or less than 10 kilograms

Yang

Huang

Chen

et al. 2015

WJG

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“…19 The donor and recipient evaluation and hepatectomies for liver transplant were performed as previously described. [20][21][22] There were no transplants that had ABO incompatibility. In all right lobe transplants, the grafts were excised without the middle hepatic vein.…”

Section: Evaluation and Proceduresmentioning

confidence: 99%

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2014

Exp Clin Transplant

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“…In Asia, living donor LT (LDLT) has been emerging as the solution of organ shortage to treat HCC. At Kaohsiung Chang Gung Memorial Hospital, the first case of LDLT was performed for a pediatric patient with biliary atresia in 1994, and progressed to adult LDLT in 1999 (3). In the high endemicity of hepatitis B and C (HBV and HCV), HCC has become the most indication for LT.…”

Section: Review Article On Liver Transplantation For Hepatocellular Cmentioning

confidence: 99%

Living donor liver transplantation for hepatocellular carcinoma achieves better outcomes

Lin

Chen

2016

Hepatobiliary Surg. Nutr.

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Liver transplantation (LT) for hepatocellular carcinoma (HCC) at Kaohsiung Chang GungMemorial Hospital mainly relies on live donor LT (LDLT). Owing to taking the risk of LD, we are obligated to adopt strict selection criteria for HCC patients and optimize the pre-transplant conditions to ensure a high disease-free survival similar to those without HCC, even better than deceased donor LT (DDLT).Better outcomes are attributed to excellent surgical results and optimal patient selection. The hospital mortality of primary and salvage LDLT are lower than 2% in our center. Although Taiwan Health Insurance Policy extended the Milan to University of California, San Francisco (UCSF) criteria in 2006, selection criteria will not be consolidated to take into account only by the morphologic size/number of tumors but also by their biology. The criteria are divided into modifiable image morphology, alpha fetoprotein (AFP), and positron emission tomography (PET) scan with standard uptake value (SUV) and unmodifiable unfavorable pathology such as HCC combined with cholangiocarcinoma (CC), sarcomatoid type, and poor differentiation. Downstaging therapy is necessary for HCC patients beyond criteria to fit all modifiable standards. The upper limit of downstaging treatment seems to be extended by more effective drug eluting transarterial chemoembolization in cases without absolute contraindications. In contrast, the pitfall of unmodifiable tumor pathology should be excluded by the findings of pretransplant core biopsy/resection if possible. More recently, achieving complete tumor necrosis in explanted liver could almost predict no recurrence after transplant. Necrotizing therapy is advised if possible before transplant even the tumor status within criteria to minimize the possibility of tumor recurrence. LDLT with low surgical mortality in experienced centers provides the opportunities of optimizing the pre-transplant tumor conditions and timing of transplant to achieve better outcomes.

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Living Donor Liver Transplantation for Biliary Atresia: A Single-Center Experience with First 100 Cases

Cited by 106 publications

References 37 publications

Living donor liver transplantation with body-weight more or less than 10 kilograms

Living donor liver transplantation with body-weight more or less than 10 kilograms

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Living donor liver transplantation for hepatocellular carcinoma achieves better outcomes

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