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[Surgery of liver transplantation in children]
J Valayer1, F Gauthier, T Yandza
1Département de pédiatrie, hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
Insights
Pediatric orthotopic liver transplantation (OLT) using reduced-size grafts in children with end-stage liver disease presented significant challenges. Hepatic artery thrombosis was a major complication, leading to retransplantation and early postoperative deaths.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplantation Medicine
Context:
- Between 1988 and 1992, 94 children with end-stage liver disease underwent orthotopic liver transplantation (OLT) at Bicetre Hospital.
- The study involved 111 OLT procedures, with a significant proportion (58%) utilizing reduced-size grafts due to donor-recipient size discrepancies.
Purpose:
- To evaluate the outcomes and complications of pediatric orthotopic liver transplantation (OLT).
- To analyze the specific challenges associated with reduced-size grafts in pediatric liver transplantation.
Summary:
- Reduced-size grafts were prepared in 64% of the 111 OLTs performed on children aged 3 years and 3 months on average.
- Complications necessitated reoperation in 42 children, with hepatic artery thrombosis occurring in 14 cases, leading to 7 retransplantations.
- Early postoperative mortality was observed in 8 patients, highlighting the complexity of the procedure.
Impact:
- This study underscores the critical complications, such as hepatic artery thrombosis, in pediatric liver transplantation.
- Findings emphasize the need for advanced surgical techniques and vigilant postoperative care in pediatric OLT.
- The data provides valuable insights into the risks and outcomes of OLT in a pediatric population, informing future strategies.
Abstract:
From 1988 until 1992, 94 children with end-stage liver disease were put forward for orthotopic liver transplantation (OLT) by the surgical and anesthesic teams of the Bicetre Hospital. Due to a majority of adult donors, and to the young age of the recipients (mean = 3 years 3 months), a reduced-size graft was prepared in 64 out of the 111 transplants performed (58%). A number of children (42) had to be reoperated on due to complications: hepatic artery thrombosis, one of the most severe complications following pediatric OLT, occurred in 14 cases, and was an indication for seven out of the 17 retransplantations in this series. The eight deaths which occurred in the early postoperative period were the toll of this particularly challenging surgery.