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Development of liver size and perfusion after reduced-size liver transplantation in children
P F Hoyer1, B Rodeck, M Scherbring
1Universitäts-Kinderklinik Essen, Essen, Germany. peter.hoyer@uni-essen.de
Insights
Segmental liver transplantation (s-LTx) in children shows comparable long-term outcomes to whole liver transplantation (w-LTx). Both methods result in adequate liver growth and normal blood flow, demonstrating s-LTx as a viable alternative.
Area of Science:
- Pediatric Surgery
- Transplantation Medicine
- Hepatology
Background:
- Segmental liver transplantation (s-LTx) addresses donor liver shortages for pediatric recipients.
- Assessing long-term adaptive liver growth and hemodynamics in pediatric s-LTx is crucial but data is limited.
Purpose of the Study:
- To compare morphometric and hemodynamic parameters in children undergoing segmental liver transplantation (s-LTx) versus whole liver transplantation (w-LTx).
- To evaluate the long-term functional adaptation of segmental liver grafts in pediatric recipients.
Main Methods:
- Seventeen children receiving s-LTx and 25 receiving w-LTx were studied 1 and 2 years post-transplant.
- Liver dimensions were assessed using grayscale ultrasound.
- Hemodynamic parameters, including hepatic artery and portal vein velocities, were measured using Doppler sonography.
Main Results:
- One and two years post-transplant, liver dimensions in both s-LTx and w-LTx groups were within the upper normal range.
- Portal vein blood flow velocities were within normal ranges for both groups.
- While hepatic artery Vmax was reduced in s-LTx, it was comparable to the reduction seen in w-LTx.
Conclusions:
- Segmental liver transplantation (s-LTx) leads to adequate liver size and normal portal vein blood flow in pediatric recipients.
- The long-term functional adaptation of s-LTx is not inferior to that of whole liver transplantation (w-LTx).
- s-LTx is a viable alternative for pediatric liver transplantation, offering comparable outcomes to w-LTx.
Abstract:
The technique of segmental liver transplantation (s-LTx) provides a method to overcome the shortage of suitable livers for small recipients. Patient survival rates are parallel to those obtained with whole liver transplantation (w-LTx). For long-term rehabilitation, adaptive liver growth and adequate perfusion is crucial; however, morphometric and hemodynamic parameters in growing children with s-LTx are not available. Seventeen children who received a s-LTx and 25 with a w-LTx who had follow-up evaluation 1 and 2 yr after LTx were studied. Mean age at time of transplantation was 4.3 +/- 3.5 yr for s-LTx and 10.3 +/- 6.0 yr for w-LTx, mean height 98 +/- 21 cm and 122 +/- 30 cm respectively. At follow-up evaluation mean values for liver enzymes, bilirubin and prothrombin time were in the normal ranges for both groups. Liver dimensions were measured by gray scale ultrasound, and hemodynamic parameters by Doppler sonography in the portal vein and hepatic artery using an Acuson 128 machine. Maximal (Vmax), minimal (Vmin) and time-average velocity (TAV) were measured and the resistive index (RI) calculated. We found that 1 and 2 yr after LTx liver dimensions were at a mean in the upper normal range of healthy controls. Spleen size was above the normal range and did not show any tendency towards regression. Mean Vmax in the hepatic artery in s-LTx and w-LTx was 48 cm/sec vs. 28 cm/sec after 1 yr and 30 cm/sec vs. 35 cm/sec after 2 yr, the RI 0.66 vs. 0.55 and 0.59 vs. 0.73, respectively (p for all parameters > 0.05). Maximal portal vein flow was 25 cm/sec in s-LTx vs. 29 cm/sec in w-LTx. Blood flow calculated by vessel diameter and TAV showed no statistical difference between both groups. In conclusion, liver size after s-LTx and w-LTx was increased to the upper normal range, and portal vein blood flow velocities were within the normal range. Vmax in the hepatic artery was reduced in s-LTx; however, the reduction was to the same extent as in w-LTx. In the view of long-term functional adaptation, s-LTx is not inferior to w-LTx.