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Results of split liver transplantation in children
Rahul R Deshpande1, Matthew J Bowles, Hector Vilca-Melendez
1Institute of Liver Studies, Kings College Hospital, Denmark Hill, London, United Kingdom.
Insights
Pediatric split liver transplantation using the ex situ technique offers good outcomes, with high patient and graft survival rates. This method effectively increases donor liver availability for children needing transplants.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Split liver transplantation is a vital strategy to address the shortage of donor organs for pediatric recipients.
- This technique allows a single liver graft to be divided for use in two patients, maximizing organ utilization.
Purpose of the Study:
- To evaluate the outcomes of 80 consecutive pediatric split liver transplants.
- To assess patient and graft survival, as well as complications, in pediatric recipients of split liver grafts.
Main Methods:
- Retrospective analysis of 80 pediatric split liver transplants performed between 1994 and 2000.
- The ex situ splitting technique was predominantly used, with follow-up ranging from 6 to 84 months.
- Patients were categorized into acute (n=16) and chronic (n=64) liver failure groups.
Main Results:
- Overall 6-month patient survival was 96.2% and graft survival was 93.7%.
- 1-year patient survival was 93.5% and 3-year survival was 88.1%.
- Vascular and biliary complication rates were 7.5% and 8.7%, respectively.
Conclusions:
- Ex situ split liver transplantation in children yields favorable patient and graft survival rates.
- The procedure is associated with acceptable morbidity, making it a viable option for pediatric liver transplantation.
- This single-institution experience highlights the effectiveness of split liver transplantation in increasing graft availability for pediatric patients.
Objective:
To analyze the outcome of 80 consecutive pediatric split liver transplants performed at the authors' center between 1994 and 2000.
Summary Background Data:
Split liver transplantation has become an accepted method of increasing the number of available grafts for pediatric liver transplant recipients.
Methods:
The age of the patients at the time of transplantation ranged from 5 days to 16 years (median 3 years). Sixteen transplants were performed for acute liver failure and 64 for chronic liver failure. The ex situ splitting technique was used for all but four grafts. Fourteen livers were split for two pediatric recipients. Posttransplant follow-up ranged from 6 to 84 months (median 42 months).
Results:
Overall patient survival at 6 months follow-up was 96.2%. Graft survival at six months was 93.7%. The Kaplan-Meier patient survival rates at 1 and 3 years were 93.5% and 88.1%, and the graft survival rates were 89.7% and 86.1%, respectively. Four patients required retransplantation. In the acute group (n = 16), the patient survival rates were 93.7% at 1 year and 76.4% at 3 years; there were three deaths due to posttransplant lymphoproliferative disease (PTLD), sepsis, and chronic rejection. In the chronic group (n = 64), the 1- and 3-year patient survival rates were 93.6% and 90.9%, respectively. There were six deaths in this group. Four patients died in the first year after the transplant due to intracranial bleeding, cerebral tumor recurrence, PTLD, and chronic rejection. There were two deaths at 3 years, one due to progressive renal failure secondary to cyclosporin toxicity and the other due to sepsis, portal hypertension, and recurrent bleeding. Vascular complications occurred in six (7.5%) patients and biliary complications in seven (8.7%).
Conclusions:
These results, which represent the experience of a single institution over the last 6 years, indicate that ex situ split liver transplantation can be performed in children with good overall outcome and acceptable morbidity.