Is size the only determinant of delayed abdominal closure in pediatric liver transplant?
Shirin Elizabeth Khorsandi1, Arthur William Raven Day1, Miriam Cortes1
1Institute of Liver Studies, King's College Hospital, London, United Kingdom.
Insights
Delayed abdominal closure in pediatric liver transplantation (LT) is primarily associated with acute liver failure (ALF), not graft-to-recipient weight ratio (GRWR). Early delayed closure within six weeks optimizes outcomes without impacting graft or child survival.
Area of Science:
- Pediatric Surgery
- Hepatology
- Transplantation Medicine
Background:
- Abdominal closure technique is crucial in pediatric liver transplantation (LT).
- Factors influencing delayed abdominal closure and its impact on outcomes require elucidation.
Purpose of the Study:
- To identify factors associated with delayed abdominal closure in pediatric LT.
- To evaluate the effect of delayed abdominal closure on patient and graft outcomes.
Main Methods:
- Retrospective analysis of a prospectively maintained database of pediatric LT recipients (≤18 years) from October 2010 to March 2015.
- Comparison of outcomes between primary and delayed abdominal closure groups.
- Analysis of factors including age, graft-to-recipient weight ratio (GRWR), and indication for LT (acute liver failure [ALF] vs. chronic liver disease [CLD]).
Main Results:
- Acute liver failure (ALF) was significantly associated with delayed abdominal closure compared to chronic liver disease (CLD) (P < 0.001).
- Children undergoing primary closure experienced shorter hospital stays, reduced pediatric intensive care unit (PICU) time, and less ventilation duration.
- Vascular complications, graft survival, and child survival were similar between primary and delayed closure groups.
- Early delayed closure (within 6 weeks) was associated with shorter ventilation and PICU durations.
Conclusions:
- Acute liver failure, not GRWR, is the primary determinant for delayed abdominal closure in pediatric LT.
- Optimal timing for delayed abdominal closure is within six weeks post-transplant.
- Delayed abdominal closure does not adversely affect graft or child survival rates.
Abstract:
The aim was to determine the factors associated with the use of delayed abdominal closure in pediatric liver transplantation (LT) and whether this affected outcome. From a prospectively maintained database, transplants performed in children (≤18 years) were identified (October 2010 to March 2015). Primary abdominal closure was defined as mass closure performed at time of transplant. Delayed abdominal closure was defined as mass closure not initially performed at the same time as transplant; 230 children underwent LT. Of these, 176 (76.5%) had primary closure. Age was similar between the primary and delayed groups (5.0 ± 4.9 versus 3.9 ± 5.0 years; P = 0.13). There was no difference in the graft-to-recipient weight ratio (GRWR) in the primary and delayed groups (3.4 ± 2.8 versus 4.1 ± 2.1; P = 0.12). Children with acute liver failure (ALF) were more likely to experience delayed closure then those with chronic liver disease (CLD; P < 0.001). GRWR was similar between the ALF and CLD (3.4 ± 2.4 versus 3.6 ± 2.7; P = 0.68). Primary closure children had a shorter hospital stay (P < 0.001), spent fewer days in pediatric intensive care unit (PICU; P = 0.001), and required a shorter duration of ventilation (P < 0.001). Vascular complications (arterial and venous) were similar (primary 8.2% versus delayed 5.6%; P = 0.52). Graft (P = 0.42) and child survival (P = 0.65) in the primary and delayed groups were similar. Considering timing of mass closure after transplant, patients in the early delayed closure group (<6 weeks) were found to experience a shorter time of ventilation (P = 0.03) and in PICU (P = 0.003). In conclusion, ALF was the main determinant of delayed abdominal closure rather than GRWR. The optimal time for delayed closure is within 6 weeks. The use of delayed abdominal closure does not adversely affect graft/child survival. Liver Transplantation 23 352-360 2017 AASLD.
