Crisis-Driven Autonomization of Pediatric Liver Procurement and Implantation During COVID-19: A Transition From...

Children's Hospital 2 in Ho Chi Minh City is the only public pediatric center performing pediatric liver transplantation (PLT) in Southern Vietnam. Before the COVID-19 pandemic, our PLT program was implemented and operated in collaboration with Belgian surgical teams who supported both graft procurement and implantation. The program enabled capacity-building and protocol development.

Travel restrictions necessitated a transition to a hybrid local model. Building on the Pre-COVID groundwork, the team successfully performed 12 living-donor PLTs between 10/2021 and 9/2022. Standardized protocols- developed through earlier international collaboration- were consistently applied. Procurement surgery was carried out by an experienced adult hepatobiliary surgeon from a local hospital, while the implantation was conducted by the pediatric surgical team.

Donors had a mean age of 32 ± 6.1 years. Procurement surgery lasted 422 ± 78.1 min. Mean blood loss was 237.5 ± 122.7 mL, and two donors required transfusion. All donor complications were Clavien-Dindo grade I. Recipients had a median age of 28 months and a weight of 10.4 kg. Biliary atresia accounted for 91.7% of indications. Grafts included seven left lateral segments and five full-left lobes. Recipient surgeries lasted 650 ± 91.5 min; mean transfusion volume was 231.2 ± 164.3 mL; cold ischemia time was 83.2 ± 24.9 min. Complications included chylous ascites (n = 2), portal vein stenosis (n = 1), and acute rejection (n = 2). One patient died from a hospital-acquired infection.

This crisis-driven transition to local autonomization demonstrated that prior supportive preparation and implementation enabled safe and effective PLT during a global health emergency.