Pediatric Liver and Transplant Surgery: Results of an International Survey and Expert Consensus Recommendations
Caroline P Lemoine1, Omid Madadi-Sanjani2, Claus Petersen2
1Division of Transplant and Advanced Hepatobiliary Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
Insights
Pediatric liver surgery requires specialized surgeons and centralized centers of excellence. Enhanced training for pediatric hepatobiliary and transplant surgeons is crucial for improving patient outcomes and establishing best practices.
Area of Science:
- Pediatric Surgery
- Surgical Oncology
- Hepatology
Background:
- Pediatric liver surgery is complex, with variable practices and potential for severe complications.
- There is a need to establish best practices for managing children undergoing liver surgery.
- This study aimed to assess current practices and develop recommendations.
Purpose of the Study:
- To evaluate individual and institutional practices in pediatric liver surgery.
- To identify areas for improvement in the management of pediatric liver conditions.
- To formulate evidence-based recommendations for pediatric liver surgery.
Main Methods:
- A web-based survey was distributed to pediatric surgery faculty within the Biliary Atresia and Related Disorders (BARD) consortium and the European Reference Network-Rare Liver.
- The Delphi method was employed to refine questions and explore future developments.
- Survey response rates were 70.6% for the initial survey and 26.5% for the Delphi questionnaire.
Main Results:
- Most centers had pediatric subspecialties, but pediatric oncology was least represented (79.2%).
- There was strong agreement on the necessity of advanced imaging (including ERCP) and pediatric transplant programs in centers performing liver tumor surgery.
- A majority of respondents (56%) believed pediatric liver transplantation should be performed by specialized pediatric surgeons.
Conclusions:
- Pediatric liver surgery should be centralized in regional centers of excellence with comprehensive pediatric subspecialties.
- Specialized pediatric surgeons are essential for performing these complex procedures.
- Enhanced promotion of pediatric hepatobiliary and transplant training for fellows is recommended to build a skilled workforce.
Background:
Pediatric liver surgery is a complex and challenging procedure and can be associated with major complications, including mortality. Best practices are not established. The aims of this study were to evaluate surgeons' individual and institutional practices in pediatric liver surgery and make recommendations applicable to the management of children who require liver surgery.
Methods:
A web-based survey was developed, focusing on the surgical management of children with liver conditions. It was distributed to 34 pediatric surgery faculty members of the Biliary Atresia and Related Disorders (BARD) consortium and 28 centers of the European Reference Network-Rare Liver. Using the Delphi method, a series of questions was then created to develop ideas about potential future developments in pediatric liver surgery.
Results:
The overall survey response rate was 70.6% (24/34), while the response rate for the Delphi questionnaire was 26.5% (9/34). In centers performing pediatric liver surgery, most pediatric subspecialties were present, although pediatric oncology was the least present (79.2%). Nearly all participants surveyed agreed that basic and advanced imaging modalities (including ERCP) should be available in those centers. Most pediatric liver surgeries were performed by pediatric surgeons (69.6%). A majority of participants agreed that centers treating pediatric liver tumors should include a pediatric transplant program (86%) able to perform technical variant grafts and living donor liver transplantation. Fifty-six percent of responders believe pediatric liver transplantation should be performed by specialized pediatric surgeons.
Conclusion:
Pediatric liver surgery should be performed by specialized pediatric surgeons and should be centralized in regional centers of excellence where all pediatric subspecialists are present. Pediatric hepatobiliary and transplant training needs to be better promoted amongst pediatric surgery fellows to increase this subspecialized workforce.
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