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Liver transplantation in infants with biliary atresia: comparison of primary versus temporary abdominal closure
Nagoud Schukfeh1, Anna-Charlotte Holland2, Dieter P Hoyer2
1Department of General Visceral and Transplant Surgery, Division of Pediatric Surgery, Faculty of Medicine, University Duisburg-Essen, Hufelandstr. 55D, , 45147, Essen, Germany. schukfeh.nagoud@mh-hannover.de.
Insights
Primary abdominal closure is a safe option for infants undergoing liver transplantation for biliary atresia. This approach shows similar outcomes to temporary abdominal closure in pediatric liver recipients under 10kg.
Area of Science:
- Pediatric Surgery
- Hepatology
- Transplantation Medicine
Background:
- Biliary atresia (BA) is the leading cause of liver transplantation (LT) in infants.
- Infants often weigh less than 10kg at the time of LT, necessitating grafts with high graft-body weight ratios (GBWR).
- Temporary abdominal closure is frequently used due to size mismatch and concerns about portal venous flow.
Purpose of the Study:
- To evaluate the feasibility and outcomes of primary abdominal closure in infants with BA undergoing LT.
- To compare primary closure with temporary abdominal closure in this specific pediatric population.
Main Methods:
- Retrospective analysis of infants (≤10kg) with BA undergoing LT between 2004-2014.
- Comparison of patients who received primary abdominal closure (group 1) versus temporary abdominal closure (group 2).
- Analysis of postoperative clinical course, biochemical data, patient survival, and graft survival.
Main Results:
- Sixty-six LTs were performed in 57 infants; 36 in group 1 and 28 in group 2.
- Mean GBWR was 4.8, with 61% of patients having a GBWR ≥4.
- No significant differences in vascular thrombosis or intra-abdominal infection rates between groups. Patient survival was 90.1% (group 1) vs. 78.3% (group 2), and graft survival was 75% (group 1) vs. 64.3% (group 2).
Conclusions:
- Primary abdominal closure is a feasible and safe technique for infants undergoing LT for BA.
- Outcomes, including survival rates, are comparable between primary and temporary abdominal closure in this cohort.
- The study supports primary closure as a viable option, challenging the routine use of temporary closure.
Introduction:
Biliary atresia (BA) is the most frequent disease leading to liver transplantation (LT) in infants. Since the patients often require transplantation before reaching a body weight of 10 kg, it is necessary to perform living-related or split liver transplantation by using a left lateral segment. However, this graft often exceeds a graft body weight ratio (GBWR) of 4. Because of the size mismatch and poor portal venous blood flow in most recipients, temporary abdominal closure is often favoured. The aim of the present study is to investigate the feasibility of primary abdominal closure in this group of extremely small infants undergoing LT.
Patients And Methods:
All patients with the diagnosis of BA and a body weight ≤10 kg who underwent LT in our centre between January 2004 and December 2014 were included in this study. Patients who received primary abdominal closure at transplantation (group 1) were compared with those receiving temporary abdominal closure (group 2). The postoperative clinical and biochemical course was analysed. The outcome was determined and correlated with body and graft weight and the GBWR.
Results:
Sixty-six LTs were performed in 57 patients in the study period (22 male, 35 female). Thirty-six patients received primary closure (group 1). Twenty-eight patients received temporary closure (group 2). Mean age at LT was 10 months (range 3-26) and mean GBWR 4.8 (range 2.9-9.3). A GBWR ≥4 occurred in 61.1 % in group 1 and in 60.9 % in group 2. There was no significant difference between both groups concerning body weight, graft weight or GBWR. Vascular thrombosis occurred in 8 patients (22 %) and 15 patients (42 %) in group 1 and in 10 patients (36 %) and 11 patients (39 %) in group 2, respectively. Six patients (17 %) of group 1 and five patients (18 %) of group 2 developed an intraabdominal infection postoperatively. After a mean follow-up of 4.6 years (range 1 month-11.1 years), patient and graft survival were 90.1 and 75 % in group 1 and 78.3 and 64.3 % in group 2, respectively.
Conclusion:
In our study, primary abdominal closure displays a similar outcome in comparison to temporary abdominal closure.
