Living-donor liver transplantation in children

Rogiers, Xavier; Bröering, Dieter C.; Müeller, Lars; Burdelski, M.

doi:10.1007/s004230050239

Cited by 19 publications

(15 citation statements)

References 24 publications

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“…[1][2][3][4][5] LRT provides a graft of excellent quality by minimizing the cold ischemic time. Primary nonfunction (PNF) after LRT is rare.…”

Section: Discussionmentioning

confidence: 99%

“…Grading of the reperfusion damage was performed using the following definitions: none, no morphologic signs of injury; mild, changes confined to fewer than 5% of cells; moderate, changes confined to 5% to 15% of cells; and severe, changes in more than 15% of cells. Each criterion (cell ballooning, single-or multiple-cell necrosis, presence of inflammatory cells) was individually scored and a final perfusion damage score was counted by adding the individual scores (none [0], mild [1][2][3], moderate [4 -6], and severe [7][8][9]). …”

Section: Fatty Degeneration and Reperfusion Injurymentioning

confidence: 99%

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Is There Still a Need for Living-related Liver Transplantation in Children?

Bröering

Müeller²,

Ganschow³

et al. 2001

Annals of Surgery

102

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ObjectiveTo assess and compare the value of split-liver transplantation (SLT) and living-related liver transplantation (LRT). Summary Background DataThe concept of SLT results from the development of reducedsize transplantation. A further development of SLT, the in situ split technique, is derived from LRT, which itself marks the optimized outcome in terms of postoperative graft function and survival. The combination of SLT and LRT has abolished deaths on the waiting list, thus raising the question whether living donor liver transplantation is still necessary. MethodsOutcomes and postoperative liver function of 43 primary LRT patients were compared with those of 49 primary SLT patients (14 ex situ, 35 in situ) with known graft weight performed between April 1996 and December 2000. Survival rates were analyzed using the Kaplan-Meier method. ResultsAfter a median follow-up of 35 months, actual patient survival rates were 82% in the SLT group and 88% in the LRT group. Actual graft survival rates were 76% and 81%, respectively. The incidence of primary nonfunction was 12% in the SLT group and 2.3% in the LRT group. Liver function parameters (prothrombin time, factor V, bilirubin clearance) and surgical complication rates did not differ significantly. In the SLT group, mean cold ischemic time was longer than in the LRT group. Serum values of alanine aminotransferase during the first postoperative week were significantly higher in the SLT group. In the LRT group, there were more grafts with signs of fatty degeneration than in the SLT group. ConclusionsThe short-and long-term outcomes after LRT and SLT did not differ significantly. To avoid the risk for the donor in LRT, SLT represents the first-line therapy in pediatric liver transplantation in countries where cadaveric organs are available. LRT provides a solution for urgent cases in which a cadaveric graft cannot be found in time or if the choice of the optimal time point for transplantation is vital.Living-related liver transplantation (LRT) and split-liver transplantation (SLT) are surgical strategies that have led to a reduction in the pretransplant death rate in children from 20% to nearly 0%.1-5 LRT provides a graft of excellent quality by minimizing the cold ischemic time. Primary nonfunction (PNF) after LRT is rare. In addition, this procedure is elective and thus allows flexibility in choosing the optimal time for transplantation with regard to the recipient's clinical status. Because of these advantages, worldwide long-term results of LRT are equal or even superior to those obtained with cadaveric full-size or reduced-size techniques. The actual 1-year graft and patient survival rate after LRT exceeds 80%.6 -10 The expansion of LRT for adult recipients reflects the great expectations of this procedure despite the higher risks for the donor associated with major hepatectomy.Split-liver transplantation (SLT) is technically comparable to LRT. However, as in other cadaveric procedures, it is theoretically susceptible to potential negative effects resulting from...

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“…[1][2][3][4][5] LRT provides a graft of excellent quality by minimizing the cold ischemic time. Primary nonfunction (PNF) after LRT is rare.…”

Section: Discussionmentioning

confidence: 99%

Section: Fatty Degeneration and Reperfusion Injurymentioning

confidence: 99%

Is There Still a Need for Living-related Liver Transplantation in Children?

Bröering

Müeller²,

Ganschow³

et al. 2001

Annals of Surgery

102

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“…In der Literatur werden weitere grö-ßere Komplikationen wie Verletzungen an der Milz, die eine Splenektomie nach sich zogen, vaskuläre Komplikationen, intraabdominelle Abszesse und psychische Störungen berichtet [13,14,15]. Die Wahrscheinlichkeit einer Revision wird zwischen 0% und 6% der Fälle angegeben und kann vor allem bei Ileus-/Subileusbeschwerden, Gallelecks und Narbenhernien indiziert sein [16,17,18]. Sieht man vom Narkoserisiko, der Leberresektion als solche und vom postoperativen Management ab, sollten einige wichtige technische Details konsequent bei der Umsetzung einer Spende des rechtsseitigen Leberlappens beachtet werden, um die potenzielle Gefähr-dung des Spenders zu minimieren.…”

Section: Die Sicherheit Der Organspenderunclassified

Lebendlebertransplantation

Tanaka

Kaihara

2003

Der Chirurg

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Liver transplantation has evolved into the standard treatment for numerous endstage liver diseases. The increase of organ shortages led to living organ donation. In 1988 living donor liver transplantation (LDLT) was performed for the first time. Since then multiple difficulties associated with LDLT have been solved. In Kyoto we can look back on more than 900 transplantations since the initiation of our LDLT program in 1990, which is the oldest in Japan and the largest in the world. In the following we review our extensive experience with special focus on issues such as donor safety, results after LDLT, and potential complications in the recipient. Further, graft size mismatching, venous drainage from anterior segment of the right lobe graft, LDLT for hepatocellular carcinoma, AB0-incompatible transplantation, and recurrence of hepatitis C infection, which are still unsolved problems in LDLT, are described and future directions are indicated.

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“…bei Empfängern um 30-40 kg Körpergewicht wird der linke Leberlappen (Segmente II-IV+I) als Transplantat verwendet (Abb. 7) [31,44].…”

Section: Chirurgische Technikunclassified

“…Dies erfordert eine gering traumatisierende Spender-und Empfängeroperation. Durch die Planbarkeit der Operationen wird die kalte Ischämiezeit des Transplantates unter Verwendung der heute gängigen Konservierungslösungen kurz gehalten [44]. Durch eine blutsparende Operationstechnik konnte die Morbidität der Eingriffe reduziert werden [6].…”

Section: Spenderoperationunclassified

Innovationen in der Leberchirurgie durch die Transplantation mit Lebendspende

Settmacher

Neuhaus

2003

Chirurg

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Living-donor liver transplantation in children

Cited by 19 publications

References 24 publications

Is There Still a Need for Living-related Liver Transplantation in Children?

Is There Still a Need for Living-related Liver Transplantation in Children?

Lebendlebertransplantation

Innovationen in der Leberchirurgie durch die Transplantation mit Lebendspende

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