Short- and Long-Term Outcomes After Live-Donor Transplantation with Hyper-Reduced Liver Grafts in Low-Weight Pediatric Recipients

Raíces, Micaela; Czerwonko, Matías E.; Ardiles, Victoria; Boldrini, Gustavo; D’Agostino, Daniel; Pont, José Marcó del; Pekolj, Juan; Mattera, Juan; Brandi, Claudio; Ciardullo, M; Santibañés, Eduardo de; Santibañes, Martín de

doi:10.1007/s11605-019-04188-y

Cited by 14 publications

(19 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some centers to avoid the problem of LFS prefer to use the reduced left lateral segment grafts or mono‐ segmental grafts LT, but it can be associated with longer operative time in the donor or more risk of bleeding or bile leak. For the recipient, there is also an increased risk of bile leak and longer cold ischemia time in case of back table graft reduction 6–9 . Our study aimed to assess the survival and outcomes in pediatrics LT using LFS graft.…”

Section: Introductionmentioning

confidence: 99%

Large for size in pediatrics liver transplant using left lateral segment grafts: A single center experience

Zakaria

Alobthani

Elsarawy

et al. 2021

Pediatric Transplantation

View full text Add to dashboard Cite

Background There are still controversies in using the large left lateral segment in pediatrics LT, with the possibility of the problem of LFS grafts, and the use of monosegmental or reduced liver grafts in small infants. This study aimed to evaluate our experience with LFSG in pediatrics LT. Methods A cohort retrospective analysis was conducted including pediatric recipients who underwent LT between January 2011 and October 2019. We compared recipients with GRWR ≥ 4% (LFS) vs GRWR < 4% as an average for size grafts. Results There were 331 pediatric LT, 74 patients with GRWR ≥ 4%, and 257 patients with GRWR < 4%. In the group of LFS grafts, temporary abdominal closure by silicon patch was done in 39 patients (52.7%), 2 patients (2.7%) had postoperative HAT, 3 patients (4.1%) early PVT, 1 patient (1.3%) bile leak, and 3 patients (4.1%) had wound infection, with no significant difference in these complications between the 2 groups. In patients with LFS‐ grafts, the 1‐, 3‐, 5‐, and 7‐year patients survival rates were 94.6%, 91.7%, 91.7%, and 91.7%, respectively, while the survival rates in patients of the other group were 96.1%, 92.6%, 91.9%, and 91.9%, respectively, with no significant difference (p = .85). Conclusion Using LFS graft by left lateral segment in pediatric LT with potential delayed abdominal closure is a safe and feasible option with good outcomes and unnecessary need for graft reduction if performed by an experienced multidisciplinary team.

show abstract

Section: Introductionmentioning

confidence: 99%

Large for size in pediatrics liver transplant using left lateral segment grafts: A single center experience

Zakaria

Alobthani

Elsarawy

et al. 2021

Pediatric Transplantation

View full text Add to dashboard Cite

show abstract

“…Sixteen studies from a pool of sixty-two were selected (6,7,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(23)(24)(25)44) (Figure 1 and Table 1). Six articles (21,22,(26)(27)(28)45) were excluded to avoid repetition as more updated publications from the same institutions were identified.…”

Section: Resultsmentioning

confidence: 99%

“…The studies evaluated were quite heterogenous, including single case reports (6,11) and large series. Five of the sixteen studies (18,19,24,25,44) represented 82% of the total population (Table 1). In addition, the age ranged from 5 days to 22 months.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Alternatives to left lateral sector in paediatric liver transplantation—a systematic review on monosegmental and reduced grafts

Gavriilidis¹,

Hidalgo²

2022

Hepatobiliary Surg Nutr

View full text Add to dashboard Cite

Importance: In paediatric liver transplantation, excessive graft volume can represent an issue when the graft-recipient-weight-ratio (GRWR) is significantly disproportionate. The traditional left lateral sector (LLS) might too big in small infants and other alternatives are required, such as Monosegmental or Reduced (including Hyper-reduced) grafts. However, replicating the excellent results achieved with full LLS is challenging given (I) the technical complexity generating these modified grafts and (II) the need to overcome the large-for-size scenario in small infants.Objective: An appraisal of the existing experience and results of monosegmental, reduced or hyper-reduced left lateral sector grafts was performed.Data sources: A systematic search of the literature was conducted in Embase, google scholar, Cochrane library, and PubMed.Study selection: Sixteen studies from a pool of sixty-two were selected. Results: After scrutiny of the available literature, sixteen studies were included with 330 patients, transplanted with monosegmental and reduced/hyper-reduced left lateral sectors grafts. There were 10 re-grafts (6 of them <90 days). Overall, median recipient's age and weight were 7 months (5 days-22 months) and 5.8 kg (2.6-8) respectively.Median graft weight was 209 grams and median GRWR was 3.5% (range, 2.7-5.6). 120 out of the 330 pLT were monosegmental (37%) producing a smaller graft (median of 164 grams) and accordingly a lower GRWR (median 3.2%) compared to reduced LLS. Hepatic artery and portal vein thrombosis overall incidence were 1.5% and 4.2%. With a median follow-up of 39 months (range, 6-87), the overall graft and patient survival were 84% (285/340) and 89% (295/330).Conclusions: Monosegmental and Reduced/Hyper-reduced LLS grafts provide access to liver transplantation for very small recipients with excellent results, comparable to the standard LLS.

show abstract

“…Although experience with LT for infant and toddler patients has been accumulating worldwide, large-for-size graft-related problems still remain as big huddles for successful LT. The main problems of large-for-size grafts include the risk of abdominal compartment syndrome because of the recipient's small abdominal cavity, discrepancies in vessel size, insufficient portal circulation, and insufficient tissue oxygenation [6][7][8][9][10]. Size reduction of the graft is a definite treatment to prevent these critical problems.…”

Section: Discussionmentioning

confidence: 99%

Pediatric deceased donor liver transplantation with in situ size reduction for recipient-graft size matching

Namgoong

Hwang

Kim

et al. 2021

Ann Hepatobiliary Pancreat Surg

View full text Add to dashboard Cite

We present a case of pediatric deceased donor liver transplantation using a reduced whole liver graft in a 25-month-old boy weighing 12.7 kg. After he had undergone Kasai portoenterostomy for biliary atresia, his general condition deteriorated progressively. He was enrolled on the waiting list for liver transplantation with Pediatric End-stage Liver Disease score of 15. The donor was a 51-monthold boy with body weight of 20 kg. The donor-to-recipient body weight ratio was 158%. The liver graft appeared to be larger than the recipient's abdominal cavity. Thus, we planned to do in situ size reduction. Recipient surgery was performed following standard procedures. We performed graft outflow vein reconstruction using a modified piggyback technique like the double inferior vena cava method. Since the portal vein was hypoplastic, a side-to-side anastomosis technique was used. We also performed intraoperative portogram to embolize venous collaterals. After completing the graft implantation, we found that the liver graft was too large to be accommodated within the abdomen. After in situ resection of the left lateral section parenchyma, we successfully performed primary closure of the abdominal wound. This patient experienced episodes of acute rejection. He has been doing well for four years after the transplantation.

show abstract

Short- and Long-Term Outcomes After Live-Donor Transplantation with Hyper-Reduced Liver Grafts in Low-Weight Pediatric Recipients

Cited by 14 publications

References 24 publications

Large for size in pediatrics liver transplant using left lateral segment grafts: A single center experience

Large for size in pediatrics liver transplant using left lateral segment grafts: A single center experience

Alternatives to left lateral sector in paediatric liver transplantation—a systematic review on monosegmental and reduced grafts

Pediatric deceased donor liver transplantation with in situ size reduction for recipient-graft size matching

Contact Info

Product

Resources

About