Large-for-size liver transplant: a single-center experience

Area of Science:

• Hepatology
• Transplant Surgery
• Pediatric Surgery

Background:

• The ideal liver transplant graft-to-recipient weight ratio is not definitively established.
• Large-for-size liver grafts (>4% ratio) in recipients under 10 kg can lead to complications like decreased graft blood supply and dysfunction.
• These issues stem from discrepancies between small abdominal cavities and large grafts.

Purpose of the Study:

• To evaluate the center's experience with large-for-size liver grafts in pediatric recipients.
• To assess the safety and efficacy of managing potential complications associated with these grafts.

Main Methods:

• Retrospective analysis of 377 orthotopic liver transplants (2001-2014).
• Focus on 188 pediatric transplants, specifically examining cases with a graft-to-bodyweight ratio > 4% in recipients < 10 kg.
• Documented use of Bogota bags and surgical interventions for complications.

Main Results:

• 58 pediatric patients (<10 kg) received grafts with a ratio > 4%.
• Bogota bags were used in 7 patients for abdominal closure due to vascular problems and abdominal hypertension; all were closed within 2 weeks.
• Post-fascia closure vascular issues were diagnosed via Doppler ultrasonography in 10 patients, managed with skin-only closure. No graft loss occurred due to the large-for-size condition.

Conclusions:

• Large-for-size grafts can cause abdominal compartment syndrome, vascular issues, and impaired oxygenation in small recipients.
• Abdominal closure with a Bogota bag is a safe and effective strategy to prevent abdominal compartment syndrome.
• Early ultrasonographic diagnosis and monitoring are crucial for avoiding graft loss in these complex cases.