Segmental ABO‐incompatible liver graft from a donor after cardiac death in neonatal acute liver failure

Abstract

Segmental liver grafts from DCD in pediatric LT have been safely used even in acute liver failure situations. Furthermore, despite the risk of antibody-mediated acute rejection, some studies have also demonstrated the safety of ABO incompatible LT in infants. The use of such grafts can be beneficial by reducing the time on the transplant waiting list but they are more susceptible to initial dysfunction and there is a lack of enthusiasm to consider their use especially for an emergency LT as a life-saving procedure. In this short article, we describe the use and successful outcome in a neonate with fulminant acute liver failure secondary to neonatal hemochromatosis who received an ABO-incompatible reduced-size DCD graft.

Pediatric Donation After Circulatory Determination of Death

“…pDCDD Liver Transplantation. One hundred eight liver transplants were reported in eight retrospective studies (39,46,60,80,89,93,96,98). One database review with 29 pDCDD donors reported 3-year graft and patient survival of 72% and 87%, respectively, which was not significantly different from NDD donors (39).…”

“…Another case series reported that two recipients and their pDCDD liver grafts survived at least 3 years (80). The remaining references reported good short-term results but did not report long-term outcomes (89,93,96,98).…”

Neonatal haemochromatosis with reversible pituitary involvement

“…In small infants in whom a left lateral segment is often large for size, liver transplantation using either mono‐segment II or III is a technically challenging, effective option. To reduce the wait time on the list, nonanatomical resection and transplantation of segments II and III have been performed and ABO‐incompatible grafts have been used successfully . In the neonate described in the present report, an ABO‐incompatible LT together with exchange transfusions and the use of rituximab resulted in good control of humoral immunity and favourable outcome.…”

Donation after Circulatory Death in Paediatric Liver Transplantation: Current Status and Future Perspectives in the Machine Perfusion Era

“…Later, the Birmingham group described in different series 7 children transplanted with DCD liver grafts from paediatric and young adult donors [ 20 – 22 ]. In 2009, the first cases of successful use of reduced DCD liver grafts in 2 children with acute liver failure, aged 10 weeks and 6 years, respectively, were described [ 20 ].…”

“…Subsequently, Gozzini et al from the same center reported 4 other paediatric DCD LT with no graft or patient loss at 19 months of follow-up, although 2 children developed mild ischemic cholangiopathy, which was treated conservatively [ 21 ]. In 2010, a neonate with fulminant acute liver failure secondary to neonatal hemochromatosis was successfully transplanted with an ABO-incompatible reduced-size DCD graft [ 22 ]. Following these initial experiences, the Birmingham group defined their criteria to select a suitable DCD donor for paediatric LT recipients which included the following: donor age < 40 years, ITU stay < 5 days, normal liver function tests (LFTs), donor WIT < 30 minutes, CIT < 8 hours, and good appearance and perfusion of the liver [ 21 ].…”