Increased morbidity associated with secondary abdominal closure in pediatric liver transplantation
Carolina Magalhães Costa1, Eduardo A Fonseca1,2, Renata Pugliese1,2
1Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, Brazil.
Insights
Secondary abdominal closure is needed in 8.7% of pediatric liver transplants (PLT). Male donors and lower recipient-to-donor body weight ratios increase the risk of requiring this procedure in PLT.
Area of Science:
- Hepatology and Transplant Surgery
- Pediatric Surgery
- Abdominal Compartment Syndrome Management
Background:
- Pediatric liver transplantation (PLT) faces challenges due to size discrepancies between donor and recipient organs.
- Secondary abdominal closure is often required to prevent abdominal compartment syndrome in PLT.
- Identifying risk factors for secondary closure is crucial for optimizing PLT outcomes.
Purpose of the Study:
- To identify variables associated with an increased risk of requiring secondary abdominal closure in pediatric liver transplantation.
- To analyze pretransplant, perioperative, and postoperative data in relation to secondary closure necessity.
Main Methods:
- Retrospective analysis of primary liver transplantations in patients under 18 years old (January 2014 - July 2022).
- Primary endpoint: risk of secondary abdominal closure.
- Analysis of pretransplant status, perioperative, and postoperative data.
Main Results:
- 58 out of 664 PLT recipients (8.7%) required secondary abdominal closure.
- Lower recipient-to-donor body weight ratio (RDBW) was significantly associated with secondary closure (p=0.001).
- Male donor sex was identified as an independent risk factor for secondary abdominal closure (HR 1.9, p=0.030).
Conclusions:
- Patients needing secondary closure were smaller with lower RDBW and received larger grafts relative to their weight (higher GRWR).
- Graft size modulation and secondary abdominal closure are key techniques to prevent compartment syndrome in PLT.
- These strategies are particularly important for low-body-weight pediatric recipients.
Background:
The discrepancy in size between donor and recipient presents a complex challenge in pediatric liver transplantation (PLT), often necessitating secondary abdominal closure to prevent abdominal compartment syndrome. The aim of this study is to determine the variables associated with an increased risk of requiring secondary closure in PLT.
Methods:
The retrospective study analyzed all primary liver transplantations performed in patients under 18 years of age from January 2014 to July 2022. The primary endpoint was the risk of secondary abdominal closure. Variables analyzed included pretransplant status, perioperative and postoperative data.
Results:
A total of 664 PLT recipients were identified, of which 58 required secondary abdominal closure (8.7%). Most patients had biliary atresia (n=412, 62.0%), followed by metabolic diseases (n=78, 11.7%). Statistical difference were found in donor gender (p=0.020) and the recipient-to-donor body weight ratio (RDBW), which was lower in the secondary closure group (0.1±0.1 vs. 0.2±0.27; p=0.001), lower in secondary closure. The mean hospital and intensive care unit (ICU) stay after PLT was significantly longer in the intervention group compared to those with primary abdominal closure (24.4±20.4 days vs. 12.5±13.1 days, p<0.001). Multivariable Cox regression analysis identified male donor as an independent risk factor for secondary abdominal closure (hazard ratio 1.9, p=0.030).
Conclusions:
Patients requiring secondary closure were smaller, had a lower RDBW, and received grafts with a higher graft-to-recipient weight ratio (GRWR), Graft size modulation and secondary abdominal closure are currently the techniques used to prevent compartment syndrome in PLT, particularly for children with low body weight.
