Pediatric liver transplant outcome using severe hypernatremic donors.

Area of Science:

• Hepatology
• Transplantation Surgery
• Pediatric Critical Care

Background:

• Pediatric liver transplantation faces donor limitations, necessitating the use of extended donor criteria grafts.
• The safety and efficacy of using severe hypernatremic donors (SHD) in pediatric liver transplantation remain underexplored.
• This study investigates outcomes of pediatric liver recipients from SHD.

Purpose of the Study:

• To evaluate the outcomes of pediatric liver transplant recipients who received grafts from severe hypernatremic donors.
• To assess patient and graft survival rates in this specific donor criteria group.
• To identify potential complications associated with using SHD in pediatric liver transplantation.

Main Methods:

• Retrospective review of clinical records for pediatric liver transplant patients at Hospital Luis Calvo Mackenna, Santiago, Chile, over the last 3 years.
• Analysis of patient and graft survival.
• Evaluation of complications potentially linked to donor hypernatremia.

Main Results:

• Five of 33 deceased donor liver transplants involved SHD, with recipients in acute conditions, including one with acute liver failure (ALF).
• Donor serum sodium levels ranged from 157-172 mEq/L at procurement.
• One patient experienced sepsis from biliary complications; another with ALF had primary graft nonfunction but recovered after re-transplantation. No other complications were noted.

Conclusions:

• Severe hypernatremic donors can be considered for pediatric liver transplantation under specific, urgent circumstances.
• Careful patient selection and management are crucial when utilizing extended criteria donors.
• This approach may expand donor pool options for critically ill pediatric liver transplant candidates.