Living Donor Liver Transplantation in Pediatric Patients With Acute Liver Failure: Safe and Effective Alternative

Uribe, Mario; González, G.; Alba, A.; Godoy, J.; Ferrario, M.; Hunter, B.; Íñiguez, R.; Cavallieri, S.; Díaz, V.; Macho, L; Ferrón, S.; Buckel, E.

doi:10.1016/j.transproceed.2008.03.128

Cited by 17 publications

(11 citation statements)

References 14 publications

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“…Liver biopsy was performed in about a third of our patients. Recent studies have demonstrated that liver biopsy in PALF helps in establishing the etiology, studying the immune response, and assessing the degree of liver necrosis . The second most common liver biopsy approach was transjugular seen in 14.5% of the biopsies performed in our study; this approach is considered safe procedure even in the presence of coagulopathy .…”

Section: Discussionmentioning

confidence: 56%

Use of Pediatric Health Information System database to study the trends in the incidence, management, etiology, and outcomes due to pediatric acute liver failure in the United States from 2008 to 2013

Kulkarni

Pérez

Pichardo

et al. 2015

Pediatric Transplantation

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Data were collected of children admitted with ALF to 16 US pediatric liver transplant centers from 2008 to 2013 using the PHIS for a retrospective analysis of PALF trends. Patient data linked to the principal diagnosis code for acute necrosis of the liver (570.00) were analyzed for the following: demographics, regional differences, changes over time, pharmaceutical trends, procedural trends, associated diagnoses, and patient outcomes. In 52.5% of 583 patients who met the selection criteria for PALF, the etiology remained undetermined. Acetaminophen toxicity (18.7%) was the most common identifiable etiology, and hepatic encephalopathy (38.6%) was the most common complication. Mortality was lower than previously reported; 95.4% survived and 73.2% survived without a liver transplant. Acute respiratory failure (OR = 3.4, p = 0.035), acute kidney injury (OR = 3.6, p = 0.003), and cerebral edema (OR = 3.6, p = 0.02) were independently associated with increased risk of mortality. The use of N-acetylcysteine in non-acetaminophen-related ALF, the use of intracranial pressure monitoring, and the proportion of sepsis decreased significantly during the study period. The PHIS database can be a useful tool to study the future trends of PALF patients.

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Section: Discussionmentioning

confidence: 56%

Use of Pediatric Health Information System database to study the trends in the incidence, management, etiology, and outcomes due to pediatric acute liver failure in the United States from 2008 to 2013

Kulkarni

Pérez

Pichardo

et al. 2015

Pediatric Transplantation

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“…There are limited data in the literature about ALF patients treated with LDLT. The survival of pediatric patients with ALF after LDLT is comparable, or even better, in comparison with patients after DDLT [ 12 , 26 ] ranging between 60% and 75% [ 7 , 23 , 27 ]. However, clinical outcomes of LDLT after ALF are worse than those in cases performed as planned non-urgent LDLT [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Acute liver failure in children—Is living donor liver transplantation justified?

et al. 2018

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ObjectivesLiving donor liver transplantation (LDLT) in patients with acute liver failure (ALF) has become an acceptable alternative to transplantation from deceased donors (DDLT). The aim of this study was to analyze outcomes of LDLT in pediatric patients with ALF based on our center’s experience.Material and methodsWe enrolled 63 children (at our institution) with ALF who underwent liver transplantation between 1997 and 2016. Among them 24 (38%) underwent a LDLT and 39 (62%) received a DDLT. Retrospectively analyzed patient clinical data included: time lapse between qualification for transplantation and transplant surgery, graft characteristics, postoperative complications, long-term results post-transplantation, and living donor morbidity. Overall, we have made a comparison of clinical results between LDLT and DDLT groups.ResultsFollow-up periods ranged from 12 to 182 months (median 109 months) for LDLT patients and 12 to 183 months (median 72 months) for DDLT patients. The median waiting time for a transplant was shorter in LDLT group than in DDLT group. There was not a single case of primary non-function (PNF) in the LDLT group and 20 out of 24 patients (83.3%) had good early graft function; 3 patients (12.5%) in the LDLT group died within 2 months of transplantation but there was no late mortality. In comparison, 4 out of 39 patients (10.2%) had PNF in DDLT group while 20 patients (51.2%) had good early graft function; 8 patients (20.5%) died early within 2 months and 2 patients (5.1%) died late after transplantation. The LDLT group had a shorter cold ischemia time (CIT) of 4 hours in comparison to 9.2 hours in the DDLT group (p<0.0001).ConclusionsLDLT is a lifesaving procedure for pediatric patients with ALF. Our experience showed that it may be performed with very good results, and with very low morbidity and no mortality among living donors when performed by experienced teams following strict procedures.

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“…A similar case in Era 2 was successfully retransplanted with a deceased donor liver. The LDLT option does broaden the organ options in the FHF scenario, [9] although it is contentious whether this can be applied in the setting of graft failure after a deceased donor graft.…”

Section: Discussionmentioning

confidence: 99%

“…[9,10] An obviously life-saving operation for the recipient, the donor operation places an otherwise well individual at risk of morbidity and mortality, documented at 0 -67% morbidity (overall average 35%) and 0.2 -0.4% mortality. [11] In addition, the decision to donate needs to be made without coercion from other family members; [10] a meticulous psychosocial evaluation is mandatory prior to anatomical assessment of the potential donor.…”

Section: Discussionmentioning

confidence: 99%

Paediatric liver transplantation in Johannesburg revisited: 59 transplants and challenges met

et al. 2014

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Living Donor Liver Transplantation in Pediatric Patients With Acute Liver Failure: Safe and Effective Alternative

Cited by 17 publications

References 14 publications

Use of Pediatric Health Information System database to study the trends in the incidence, management, etiology, and outcomes due to pediatric acute liver failure in the United States from 2008 to 2013

Use of Pediatric Health Information System database to study the trends in the incidence, management, etiology, and outcomes due to pediatric acute liver failure in the United States from 2008 to 2013

Acute liver failure in children—Is living donor liver transplantation justified?

Paediatric liver transplantation in Johannesburg revisited: 59 transplants and challenges met

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