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Liver transplantation with reduced-size donor organs
C E Broelsch1, J C Emond, J R Thistlethwaite
1Department of Surgery, University of Chicago, Illinois 60637.
Transplantation
|March 1, 1988
Summary
Reduced liver transplantation (RLT) offers a vital solution for pediatric patients awaiting liver transplants. This technique can increase transplant rates and improve survival by utilizing size-matched donor organs, even in urgent cases.
Area of Science:
- Hepatology
- Transplantation Surgery
- Pediatric Surgery
Background:
- Orthotopic liver transplantation (OLT) in pediatric patients is often constrained by donor organ size matching.
- Reduced liver transplantation (RLT) presents a viable strategy to overcome donor organ limitations and expand transplant eligibility.
- The study details the initial clinical application of RLT in the United States.
Purpose of the Study:
- To evaluate the initial clinical application and outcomes of reduced liver transplantation (RLT) in pediatric patients in the United States.
- To assess the feasibility and efficacy of RLT for various indications, including fulminant hepatic failure, hepatic artery thrombosis, and chronic liver disease.
- To analyze the early graft function, survival rates, and complications associated with RLT in this cohort.
Main Methods:
- Retrospective analysis of pediatric patients undergoing OLT between November 1984 and April 1987.
- Identification of patients who received reduced liver grafts, with ex-vivo resection to achieve size matching.
- Review of indications for RLT, operative details, graft function, and patient outcomes, including survival and complications.
Main Results:
- Five pediatric patients received RLT out of 33 total OLTs during the study period.
- Indications included fulminant hepatic failure, hepatic artery thrombosis, and chronic liver disease.
- Four out of five RLT recipients were alive between 2 and 48 months post-transplant, demonstrating acceptable early graft function.
- Complications included graft non-function, hemorrhage, and cytomegalovirus infection in some cases.
Conclusions:
- Reduced liver transplantation (RLT) can provide life-sustaining liver function in pediatric patients with urgent indications.
- RLT can serve as a temporary or permanent liver replacement, increasing donor organ utilization.
- Further evolution of RLT techniques may expand its application to more elective candidates, reducing size limitations in pediatric OLT.