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Short- and Long-Term Outcomes After Live-Donor Transplantation with Hyper-Reduced Liver Grafts in Low-Weight

Micaela Raices1, Matias Eduardo Czerwonko2, Victoria Ardiles2

  • 1Department of General Surgery, Division of HPB Surgery and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. micaela.raices@hospitalitaliano.org.ar.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|March 20, 2019
PubMed

Insights

Live-donor liver transplantation (LDLT) using hyper-reduced grafts offers good outcomes for pediatric patients under 10 kg. This approach addresses donor organ shortages, achieving a 74% 10-year survival rate.

Area of Science:

  • Pediatric Surgery
  • Hepatology
  • Transplantation Medicine

Background:

  • Liver transplantation (LT) is a vital treatment for pediatric liver failure.
  • A significant challenge in pediatric LT is the scarcity of size-matched donor organs, particularly for infants under 10 kg.
  • Large grafts can lead to poor outcomes due to insufficient oxygenation and compression.

Purpose of the Study:

  • To assess the short- and long-term results of live-donor liver transplantation (LDLT) utilizing hyper-reduced grafts in low-weight pediatric recipients.
  • To address the limitations of previous studies with small sample sizes and lack of long-term follow-up.

Main Methods:

  • A retrospective analysis of 59 pediatric patients weighing less than 10 kg who underwent hyper-reduced LDLT.
  • Data collected from February 1994 to February 2018.

Main Results:

  • Biliary atresia was the most common reason for liver failure (70%).
  • The median recipient weight was 8 kg, with a median follow-up of 40.3 months.
  • The 10-year overall survival rate was 74%, though vascular (15%) and biliary (45%) complications were noted. A PELD score >23 indicated higher complication risk.

Conclusions:

  • Hyper-reduced LDLT is a viable option for children under 10 kg, yielding positive outcomes.
  • Successful implementation requires high-volume centers and experienced surgical teams.
  • This technique effectively overcomes donor organ size limitations in pediatric liver transplantation.
Abstract

Keywords:
Biliary leakGraft failureLiver failureMortalityPELD

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