Pediatric liver transplantation using left hepatic segments from living related donors: Surgical experience in 100 recipients at Saint‐Luc University Clinics

Abstract

Living-related liver transplantation was developed in the context of deceased donor organ shortage, which is particularly acute for pediatric recipients. This retrospective study analyzes the surgical technique and complications in the first 100 pediatric liver transplantation using left segmental liver grafts from living donors, performed at Saint-Luc University Clinics between July 1993 and April 2002. Pre-operative evaluation in donors and recipients, analysis of the surgical technique, and postoperative complications were reviewed. After a median follow-up period of 2526 days, no donor mortality was encountered, with a minimal morbidity and no long-term sequelae. At one and five yr post-transplantation, the actuarial patient survival rates were 94% and 92%, the corresponding figures being 92% and 89% for graft survival. The incidences of portal vein and hepatic artery thromboses, and of biliary complications were 14%, 1%, and 27%, respectively. Living-related liver transplantation in children constitutes an efficient therapy for liver failure to face the increased demand for liver grafts. Donor morbidity was kept to acceptable incidence, and surgical technique in the recipient needs to be tailored to minimize postoperative complications.

Living-Related Versus Deceased Donor Pediatric Liver Transplantation: A Multivariate Analysis of Technical and Immunological Complications in 235 Recipients

“…The technical details of the DD whole, reduced-size and split liver grafts were previously reported (7,10). The University of Wisconsin preservation solution was used for graft preservation in both groups.…”

“…The University of Wisconsin preservation solution was used for graft preservation in both groups. The liver grafts retrieved from the LD were transplanted orthotopically in the recipients, following a surgical procedure recently described in detail (7). In case of portal vein hypoplasia, a jump venous graft was implanted between the recipient superior mesenteric vein and the portal vein of the liver graft, this venous graft being either the recipient left internal jugular vein or a preserved iliac vein from a DD (7).…”

“…In this protocol, the role of donor's advocate is assumed by the internist who assesses the medical condition and operative risks of the potential donor, and who is not a member of the transplant team. Finally, several strategic options are offered to the parents of a child candidate to LT: (1) listing on the DD waiting list, with possibility for secondary living donation if the child's condition deteriorates (backup option); (2) evaluation of a potential LD, with registration of the recipient on the DD list in case of any contraindication in the potential donor; (3) listing for living donation as confirmed option (7)(8)(9).…”

Risk factors and surgical management of anastomotic biliary complications after pediatric liver transplantation

“…[6][7][8][9] The following surgical characteristics were collected: total, cold, and warm (anastomosis) ischemia times; number of hepatic arteries in the graft; number of reconstructed hepatic arteries and number of ligated arteries in the graft; number of biliary anastomoses; site of the biliary anastomosis [common bile duct (CBD), common hepatic duct (CHD), or left hepatic duct (LHD)]; type of biliary reconstruction (hepaticojejunostomy, duct-to-duct anastomosis, or hepaticoduodenostomy); and type of abdominal wall closure (primary or secondary). Biliary reconstruction was most frequently performed with Roux-en-Y hepaticojejunostomy (n 5 396 or 92%) or a duct-to-duct anastomosis (n 5 22 or 5%) without the use of a biliary drain or stent.…”

Interventional radiology for post-transplant anastomotic complications

“…Although deceased donor liver transplantation is considered a standard procedure, living donor liver transplantation (LDLT) has been widely performed owing to the shortage of donors [4] . LDLT is technically demanding because of the use of short vascular pedicles, which are more likely to cause postoperative vascular complications, such as hepatic venous outflow obstruction (HVOO) at the anastomotic site and anastomotic portal vein stenosis (PVS) [5][6][7][8] . Moreover, biliary complications remain common after LDLT, and some studies suggested that biliary stricture at the anastomotic site occurs more frequently in post-LDLT patients than in deceased liver transplantation.…”