Related Experiment Videos
[Living-related liver transplantation--first experiences at Rabin Medical Center]
N Bar-Nathan1, Z Shapira, E Shaharabani
1Dept. of Transplantation, Rabin Medical Center, Petah Tikva.
Insights
Living-related liver transplantation is a feasible option for children with acute liver failure. This technique successfully salvaged three children, demonstrating its potential to address pediatric organ shortages.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplantation Immunology
Context:
- Acute, fulminant hepatitis A in children presents a critical need for urgent liver transplantation.
- Severe jaundice, coagulopathy, and encephalopathy are key indicators for transplantation.
- Limited organ availability poses a significant challenge for pediatric liver transplant candidates.
Purpose:
- To describe the initial experience with living-related liver transplantation in pediatric patients with acute liver failure.
- To evaluate the feasibility and outcomes of using the left lateral hepatic segment from a parent donor.
- To highlight the management of post-transplantation complications, including hepatic arterial thrombosis and biliary stricture.
Summary:
- Three children (2 boys, 1 girl, aged 4-4.5 years) underwent living-related liver transplantation using the left lateral hepatic segment from a parent.
- Post-transplantation hepatic arterial thrombosis occurred in two patients but was successfully managed with early Doppler sonography, thrombectomy, and re-anastomosis.
- One patient developed an anastomotic biliary stricture, which was surgically corrected with percutaneous stenting.
- All three children are alive with normal graft function at 2, 7, and 8 months post-transplantation.
Impact:
- Living-related liver transplantation is a viable option in Israel, offering a potential solution to the critical shortage of donor organs for children.
- The described surgical technique and complication management strategies contribute to the growing body of knowledge in pediatric liver transplantation.
- Successful outcomes in these initial cases encourage further application of this life-saving procedure.
Abstract:
Our experience with living-related liver transplantation is described. In 2 boys and 1 girl, aged 4-4.5 years with acute, fulminating hepatitis A, the presence of very severe jaundice (bilirubin levels > 18 mg%) associated with severe coagulopathy (INR > 10) and encephalopathy indicated the need for urgent liver transplantation. In all 3 cases the left lateral hepatic segment of a matched blood type parent was transplanted. None of the donors suffered a serious complication postoperatively and all returned to full activity in 6-16 weeks. The post-transplantation course was uneventful in 1 child, but in the other 2 there was hepatic arterial thrombosis in 1 at 1 day and in the other at 8 days post-transplantation. Early detection of arterial thrombosis by Doppler sonography permitted salvage of the 2 hepatic grafts after thrombectomy and re-anastomosis. In 1 of these 2 children an anastomotic biliary stricture was found 2 months after transplantation. It was corrected at surgery and a percutaneous stent was inserted. All 3 children are alive with normal graft function at 2, 7 and 8 months post-transplantation, respectively. This initial experience indicates that living-related liver transplantation is feasible in Israel. The technique might help to solve our severe organ shortage for children awaiting liver transplantation.