Segmental Grafts in Adult and Pediatric Liver Transplantation

Rodríguez-Dávalos, Manuel I.; Arvelakis, Antonios; Umman, Veysel; Tanjavur, Vijayakumar; Yoo, Peter S.; Kulkarni, Sanjay; Luczycki, Stephen M.; Schilsky, Michael L.; Emre, Sükrü

doi:10.1001/jamasurg.2013.3384

Cited by 45 publications

(12 citation statements)

References 48 publications

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“…However, for adult candidates, frequency of vascular thromboses and biliary complications has abated such that they now occur in similar rates among recipients of either graft type. (10,20,21) In addition, the study might be subject to confounding by indication as candidates for whom physicians felt comfortable accepting an offer for a split graft might be different from those for whom it was declined. The possibility exists that the favorable outcomes following SLT for small children and adults were the result of careful candidate selection on the part of health care teams.…”

Section: Original Article | 981mentioning

confidence: 99%

Survival Benefit of Split‐Liver Transplantation for Pediatric and Adult Candidates

et al. 2022

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Patient and graft survival are similar following whole-liver transplantations (WLTs) versus split-liver transplantations (SLTs) among pediatric and adult recipients, yet SLTs are rarely used. We sought to determine the survival benefit associated with accepting a splittable graft offer for SLT versus declining and waiting for a subsequent offer using 2010 to 2018 Scientific Registry of Transplant Recipients (SRTR) data on 928 pediatric and 1814 adult liver transplantation candidates who were ever offered a splittable graft. We compared eventual mortality, regardless of subsequent transplants, between those patients who accepted versus declined a split liver offer with adjustments for Pediatric End-Stage Liver Disease/Model for End-Stage Liver Disease (MELD) scores, diagnosis, and weight among pediatric candidates and matching for MELD score, height, and offer among adult candidates. Among pediatric candidates ≤7 kg, split liver offer acceptance versus decline was associated with a 63% reduction in mortality (adjusted hazard ratio [aHR], 0.17 0.37 0.80 [P = 0.01]; 93.1% versus 84.0% 1-year survival after decision). Within 1 year of decline for those ≤7 kg, 6.4% died and 31.1% received a WLT. Among pediatric candidates >7 kg, there was no significant difference associated with acceptance of a split liver offer (aHR, 0.63 1.07 1.82 [P = 0.81]; 91.7% versus 94.4% 1-year survival after decision). Within 1 year of decline for those >7 kg, 1.8% died and 45.8% received a WLT. Among adult candidates, split liver offer acceptance was associated with a 43% reduction in mortality (aHR, 0.39 0.57 0.83 [P = 0.005]; 92.2% versus 84.4% 1-year survival after decision). Within 1 year of decline for adult candidates, 7.9% died and 39.3% received a WLT. Accepting split liver offers for SLT could significantly improve survival for small children and adults on the waiting list.

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Section: Original Article | 981mentioning

confidence: 99%

Survival Benefit of Split‐Liver Transplantation for Pediatric and Adult Candidates

et al. 2022

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“…22 These challenges associated with LDLT in pediatric patients highlight the need for refining surgical technique training and the importance of close collaboration with infectious disease experts for the prevention of infection-related complications, as well as quality improvement strategies. 6,23,24 Previous studies of adult LT have suggested that SSIs do not significantly affect patient survival but can significantly decrease graft survival. Among pediatric LT recipients, infection in the early postoperative period was associated with significant morbidity but no increased mortality.…”

Section: Discussionmentioning

confidence: 99%

“…5 At our center, more than 50% of our pediatric recipients received SG, mainly from living donation. 6 In adult patients, the SSI rate after LDLT is higher than that in deceased donor LT. 3,[7][8][9] SG used in LT pose added difficulty for many reasons, including the presence of a cut surface, which is known to increase the incidence of biliary complications and therefore a potential increased risk of SSIs. 10,11 Other groups have shown that the presence of SSI following LT is associated with increased postoperative morbidity, high costs, and increased resource utilization.…”

Section: Introductionmentioning

confidence: 98%

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Epidemiology and outcomes of surgical site infections among pediatric liver transplant recipients

Banach

López‐Verdugo

Sánchez-García

et al. 2022

Transplant Infectious Dis

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Introduction Surgical site infections (SSI) are a significant cause of morbidity in liver transplant recipients, and the current data in the pediatric population are limited. The goal of this study was to identify the incidence, classification, risk factors, and outcomes of SSIs among children undergoing liver transplantation (LT). Methods A single‐center, retrospective descriptive analysis was performed of patients age ≤18 years undergoing LT between September 2007 and April 2017. SSI identified within the first 30 days were analyzed. Primary endpoints included incidence, classification, risk factors, and outcomes associated with SSIs. Results We included 86 patients, eight patients (9.3%) developed SSIs. Among segmental grafts (SG) recipients, 7/61 (11.4%) developed SSI. Among whole grafts recipients, 1/25 (4%) developed SSI. SSIs were associated with the presence of biliary complications (35% vs. 3%, p < .01; odds ratios 24, 95% CI: 3.41‐487.37, p<.01). There were no differences in long term graft or patient survival associated with SSI. Patients who developed SSI were more likely to undergo reoperation (50% vs. 16.7%, p = .045) and had an increased total number of hospital days in the first 60 days post‐transplant (30.5 vs. 12.5 days, p = .001). Conclusions SSIs after pediatric LT was less frequent than what has been previously reported in literature. SSIs were associated with the presence of biliary complications without an increase in mortality. SG had an increased rate of biliary complications without an association to SSIs but, considering its positive impact on organ shortage barriers, should not be a deterrent to the utilization of SGs.

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“…246 Hepatic artery stenosis (HAS) can be a precursor to HAT, with an incidence in children of 2.8%. 247 It is diagnosed by Doppler ultrasound imaging, and the gold standard is angiography and is best managed by angioplasty and endovascular interventions. 248 Venous complications.…”

Section: Surgical Complications Vascular Complicationsmentioning

confidence: 99%

Clinical Practice Guidelines for Liver Transplantation in Saudi Arabia

Abaalkhail

Sebayel

Shagrani

et al. 2021

SMJ

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The first human liver transplantation (LT) in the Kingdom of Saudi Arabia (KSA) was performed in 1990, but the first LT program was commenced in 1994. 1 Until 1997, all LTs in KSA were from deceased donors. 1,2 The living donor LT (LDLT) program for children started in 1997, and the LDLT program for adults was initiated in 2001. 3 Thus, as of 2017, there were 2,233 LTs conducted: 1,133 livers from livingrelated donors, 95 from living-unrelated donors, and

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Segmental Grafts in Adult and Pediatric Liver Transplantation

Cited by 45 publications

References 48 publications

Survival Benefit of Split‐Liver Transplantation for Pediatric and Adult Candidates

Survival Benefit of Split‐Liver Transplantation for Pediatric and Adult Candidates

Epidemiology and outcomes of surgical site infections among pediatric liver transplant recipients

Clinical Practice Guidelines for Liver Transplantation in Saudi Arabia

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