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Intraperitoneal fluid collections following liver transplantation in a paediatric population
K A Duncan1, S E King, J F Ratcliffe
1Department of Radiology, Royal Children's Hospital, Brisbane, Queensland, Australia.
Insights
Reduced-size liver transplants (RLT) do not increase fluid collection incidence in pediatric liver transplantation. Intervention rates were similar between RLT and whole liver transplants (WLT), with no link to the liver
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplantation Immunology
Background:
- Reduced-size liver transplant (RLT) techniques are standard in pediatric liver transplantation.
- Concerns exist regarding increased post-operative fluid collections from the liver's cut surface in RLT.
Purpose of the Study:
- To evaluate the incidence and management of post-operative fluid collections after pediatric liver transplantation.
- To compare fluid collection rates between whole liver transplants (WLT) and reduced-size liver transplants (RLT).
Main Methods:
- Retrospective analysis of 70 pediatric liver transplants (18 WLT, 52 RLT) over three years.
- Detailed recording of fluid collection occurrence, distribution, and management.
- Analysis of intervention requirements and their causes.
Main Results:
- Fluid collections occurred in 39% of WLT and 44% of RLT recipients, showing similar incidence.
- Intervention was needed for 20 collections; seven in the RLT group were linked to biliary leaks or bowel perforation.
- The incidence of other fluid collections requiring intervention was comparable between WLT and RLT groups.
Conclusions:
- Reduced-size liver transplantation does not elevate the overall incidence of post-operative fluid collections.
- Increased intervention rates in RLT were not attributable to the liver's cut surface but to other complications.
Abstract:
Reduced-size liver transplant techniques are now widely used in paediatric liver transplantation programmes. An argument against their use is the potential for an increased incidence of post-operative fluid collections arising from the cut surface of the liver. The distribution and management of fluid collections after 70 paediatric liver transplants (18 whole and 52 reduced), performed over a 3 year period is reported. Fluid collections occurred in seven of the whole liver transplant (WLT) group and in 23 of the reduced-size liver transplant (RLT) group. The incidence of fluid collections in the two groups was therefore similar (39% and 44%). Intervention was required in 20 collections: in the RLT group, seven of these were due to biliary anastomosis leaks or bowel perforation, the incidence of the remaining collections requiring intervention was similar in the two groups. In conclusion the overall incidence of fluid collections was not increased by the use of reduced-size liver transplants, and the increased rate of intervention in the RLT group was not related to the cut surface.
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