Living donor liver transplantation for children in Brazil weighing less than 10 kilograms

Abstract

Infants with end-stage liver disease represent a treatment challenge. Living donor liver transplantation (LDLT) is the only option for timely liver transplantation in many areas of the world, adding to the technical difficulties of the procedure. Factors that affect morbidity and mortality can now be determined, which opens a new era for improvement. We have accumulated an 11-year experience with LDLT for children weighing Ͻ10 kg. From October 1995 to October 2006, a total of 222 LDLT in patients Ͻ18 years of age were performed; 129 primary LDLT and 7 retransplants (4 LDLT and 3 deceased donor grafts) were performed in 129 infants weighing Ͻ10 kg. Forty-seven patients received grafts with graft-to-recipient weight ratio (GRWR) of Ͼ4%. Two patients received monosegmental grafts, and 2 patients underwent delayed abdominal wall closure. Portal vein thrombosis occurred in 5.4% of the patients, hepatic artery thrombosis in 3.1%, and both in 1.5%. Among several variables studied, only the bilirubin level at the time of transplantation was associated with increased risk of death (P ϭ 0.009). Grafts with GRWR Ͼ4% had no negative effect on patient survival. There were 7 retransplants, and 4 patients received a second parental LDLT. Patient survival rates at 1, 3, and 10 years after transplantation were 88.8%, 84.7%, and 82% for all children, and 87.5%, 84.9%, and 84.9% for infants weighing Ͻ10 kg. LDLT has results comparable to other modalities of liver transplantation in infants. Monosegment grafts were rarely required in this series, although they may be necessary in patients with lower body weight.

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“…In consistent with previous 2 studies of children who had the Kasai operation for correction of biliary atresia, and those children in the pretransplant scenario exhibited malnutrition and hyperbilirubinemia. 26,27 We observed that female sex was associated with greater morbidity, similar to a previous study from Kyoto that reported that female sex and high GRWR were independent risk factors for hepatic artery thrombosis after LDLT. 28 To our knowledge, few studies have reported outcomes of ICU-bound pediatric patients after LDLT.…”

Predictors of Survival Following Liver Transplantation in Infants: A Single-Center Analysis of More Than 200 Cases

“…Despite the fact that children under one year of age represent one out of four pediatric LTx recipients (2), infants with end-stage liver disease remain a challenging and understudied group. While it has been well documented that infants historically have had the highest rates of wait-list mortality amongst all pediatric candidates (3–6), only a limited number of studies exist which investigate the outcomes of these youngest LTx recipients (7–19). To date these prior series have struggled with small sample sizes, reported wide variation in outcomes, and have been unable to clearly identify risk factors of survival for infants undergoing LTx.…”

Pediatric transplantation: preventing thrombosis

“…Jurim (1995) [79] USA R/C LT/RLT 0-10 Not described HAT 29% (LT) vs. 0% (RLT) Kamel (2006) [80] Ireland R/C KT 0-18 None GT 5% Kanmaz (2014) [13] Turkey R/C LT 0-18 ASA HAT 3.9%, PVT 6.8% Karatzas (1997) [81] USA R/C LT All Not described HAT 11.4% Khan (2014) [82] Saudi Arabia R/C KT 0- [86] Italy R/C LT, < 6 kg 0-1 Not described HAT 0%, PVT 6% [12] Switzerland R/C LT 0-18 UFH, ASA, FFP HAT 1.8%, PVT 0.9% Millis (1996) [19] USA R/C LDLT/RLT 0-3 Not described ePVT 4-33%; dPVT 4-51% Miyagi (2014) [88] Japan R/C LDLT All Protease inhibitor Not reported Nagra (2004) [48] UK R/C KT 0-17 UFH vs. No prophylaxis GT 8% vs. 11% Neto (2007) [89] Brazil P/C LDLT < 10 kg 0-18 Not described HAT 3.1%, PVT 5.4% Neto (2012) [10] Brazil P/C LDLT 0-18 Not described HAT 4.3%, ePVT 2.6%, dPVT 5.8% Neto (2014) [90] Brazil P/C LDLT 0-18 UFH/VKA in high risk, dipyridamole PVT 7%…”