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[Liver transplantation with a living related donor in the child]
F Lacaille1, J Belghiti, F Sauvat
1Département de Pédiatrie, Hôpital des Enfants-Malades, Paris.
Insights
Living donor liver transplantation offers a viable solution for pediatric patients, with a 90% survival rate. While biliary complications are frequent, the overall benefits outweigh the risks for young children.
Area of Science:
- Hepatology
- Transplant Surgery
- Pediatric Gastroenterology
Background:
- Living related donor liver transplantation (LRDLT) is a developing technique to address the shortage of deceased donor liver grafts for pediatric recipients.
- Ethical considerations regarding voluntary organ donation from healthy individuals are paramount.
- This study evaluates the outcomes of 37 living related donors undergoing liver transplantation procedures.
Purpose of the Study:
- To assess the safety and efficacy of living related donor liver transplantation in pediatric patients.
- To analyze the short-term and long-term outcomes for both donors and recipients.
- To provide insights into the risk-benefit profile of this surgical approach.
Main Methods:
- Donor surgeries and recipient follow-up were conducted at specialized surgical and hospital units.
- Donor complications, including re-operation for bleeding and biliary fistula, were recorded.
- Recipient outcomes, such as survival rates, graft function, and complication incidence, were monitored.
Main Results:
- Ninety percent (33 out of 37) of pediatric recipients survived, with one requiring a second transplant due to arterial thrombosis.
- Vascular, infectious complications, and rejection rates were comparable to deceased donor liver transplantations.
- Biliary complications occurred in 15 patients, significantly increasing post-operative morbidity.
Conclusions:
- Living related donor liver transplantation demonstrates a favorable balance of benefits and risks, particularly for very young children.
- Individual case assessment and informed parental consent are crucial for ethical considerations.
- Continued experience with LRDLT and optimization of cadaveric graft utilization are recommended.
Objectives:
Liver transplantation with living related donor has been recently developed to compensate for the insufficient number of liver grafts for children. The major problem is ethical because it implies voluntary mutilation of a healthy person. This paper report results in 37 living related donors.
Patients:
Recipients were followed in Enfants-Malades Hospital. Investigations and donor surgery were performed at the Digestive Surgery Unit of Beaujon Hospital.
Results:
One donor was re-operated for bleeding, and another one a biliary fistula treated with percutaneous drainage for one week. The post-operative course was uneventful in the other donors, with a follow-up of between 2 and 50 months. Thirty-three children are alive (90%), one of them underwent a second transplant for arterial thrombosis. Vascular and infectious complications, and the number of rejection episodes were the same as in transplantations with a deceased donor. Biliary complications were frequent (15 patients out of 37) and significantly increased morbidity. A teenage boy who received a small graft (0.9% of his weight) presented initially with hepatic insufficiency without encephalopathy.
Conclusion:
This technique has been shown to have a good balance between benefits and risks. Our experience confirms this, especially in very young children. Each case should be discussed individually and parental consent should be obtained without external pressure. Experience with this technique should be continued and at the same time the use of cadaveric grafts should be optimized.