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[Comparative study of reduced-size and whole liver transplantation in children]
M Asensio1, C Margarit, C Steimberg
1Grupo de Trasplante Hepático Pediátrico, Hospital Vall d'Hebron, Barcelona.
Insights
Reduced-size liver transplants (RLTx) offer a viable solution to increase donor availability for pediatric patients. While RLTx showed lower initial graft survival, outcomes for elective procedures were comparable to full-size liver transplants (FLTx), suggesting reduced techniques are safe.
Area of Science:
- Pediatric Surgery
- Organ Transplantation
- Hepatology
Background:
- Limited donor availability poses a significant challenge in pediatric liver transplantation, leading to high waiting list mortality.
- Liver reduction techniques, including reduced, segmental, and split liver transplantation, have been developed to expand the donor pool.
- Comparing outcomes between reduced-size and full-size liver grafts in pediatric recipients is crucial for optimizing transplant strategies.
Purpose of the Study:
- To compare the morbidity and mortality rates between pediatric patients receiving reduced-size liver transplants (RLTx) and full-size liver transplants (FLTx).
- To evaluate the effectiveness of liver reduction techniques in increasing donor availability and decreasing waiting list mortality.
- To assess graft survival rates and postoperative complications in both RLTx and FLTx groups.
Main Methods:
- A retrospective analysis was conducted comparing 27 pediatric patients who underwent RLTx with 102 patients who received FLTx between June 1985 and February 2000.
- Patient demographics, donor/recipient body ratios, urgency of transplantation, intraoperative transfusion requirements, and postoperative complications were recorded.
- Graft survival rates at 3 months, 1 year, and 5 years post-transplantation were analyzed for both groups.
Main Results:
- RLTx recipients were younger and lighter, with a higher proportion undergoing urgent transplantation compared to FLTx recipients.
- RLTx required greater intraoperative red blood cell transfusions, but showed no significant differences in portal thrombosis, reintervention, or biliary complications.
- Arterial thrombosis was exclusively observed in the FLTx group. Graft survival at 5 years was 43% for RLTx versus 53% for FLTx (p=0.06); however, survival for elective RLTx was comparable to FLTx.
Conclusions:
- Liver reduction techniques can effectively expand the donor pool for pediatric liver transplantation, potentially reducing waiting list mortality.
- While RLTx may be associated with lower initial graft survival, the morbidity and mortality are not significantly increased compared to FLTx, especially in elective cases.
- RLTx represents a valuable strategy to improve access to liver transplantation for children, with comparable outcomes to FLTx in specific patient subgroups.
Abstract:
It is difficult to find adequate donors for many children with low weight. In order to increase the pool size of donors and decrease mortality on the waiting list, several reduction techniques have been developed in the last years (reduced, segmental and split liver). The aim of this study is to compare morbility and mortality in our serie between children who received a full-size liver and those who received a partial one. We retrospectively compared 27 cases of reduced-size liver transplants (RLTx) with 102 cases of full-size liver transplants (FLTx) performed between june of 1985 and february of 2000. Mean age in RLTx was 38.1 months (range 6-144) vs 70.8 months (range 5-192) in FLTx. Mean weight was 11.9 k (range 5.8-30) in RLTx vs 20.48 k (range 4.4-68) in FLTx. Mean donor/recipient body ratio was 4.88 in RLTx and 2.03 in FLTx. The indication of transplantation was urgent in 14 patients (51.8%) from the RLTx group and in 12 (11.7%) from the FLTx one. The requirements of transfusions during surgery was greater in the RLTx (177 cc/kg of RBC transfusions vs 124 cc in FLTx). There was no differences between both groups regarding other postoperative complications (portal thrombosis, need of reintervention and biliary complications). Arterial thrombosis was observed only in FLTx (12 cases). Graft survival at 3 months was 49% for the RLTx and 73% for the FLTx. It was 43% and 67%, respectively, at 1 year, and 43% and 53% at 5 years after liver transplantation (p = 0.06). If we consider only elective transplants, survival was 72% for RLTx and 75% for the FLTx at 3 months. Although survival is lower in the RLTx group, the difference is not significant. If we consider only the elective transplants, survival is almost the same in both groups. The reduction techniques are a good method to decrease mortality in the waiting list without increasing post-transplant morbidity and mortality.