Related Experiment Videos
[Related living donor for liver transplantation in children: results and impact]
J de Ville de Goyet1, R Reding, E Sokal
1Service de Chirurgie Pédiatrique, Cliniques Universitaires Saint-Luc, UCL, Bruxelles, Belgique.
Insights
Living related donor liver transplantation offers excellent results for children, increasing graft availability and reducing wait times. This approach, combined with cadaver donor transplants, improves outcomes for pediatric liver recipients.
Area of Science:
- Pediatric Surgery
- Transplantation Immunology
Context:
- Limited availability of cadaveric donor livers for pediatric liver transplantation.
- Development of alternative strategies like living related donor liver transplantation (LRDLT) is crucial.
Purpose:
- To evaluate the outcomes and impact of a living related donor liver transplantation program for children.
- To assess the safety and efficacy of LRDLT in pediatric liver recipients.
Summary:
- The LRDLT program included 32 children over 30 months with excellent survival rates (100% for elective, 86% for hospitalized patients).
- Biliary stenosis occurred in 22% of recipients, but severe complications were absent in donors.
- LRDLT increased graft availability, reduced waiting times, and improved overall management for pediatric liver transplant candidates.
Impact:
- LRDLT significantly enhances graft availability for pediatric liver transplant candidates.
- Reduced waiting times decrease the risk of mortality before transplantation.
- Combining LRDLT with cadaveric transplants positively impacts the global management of pediatric liver transplantation.
Abstract:
Encouraging results of alternative techniques used for liver transplantation in children (liver reduction) and the persistent lack of a sufficient number of cadaver donors has favored the development of living related donor liver transplantation. This program, which began after a long preparative period concerning the ethical questions involved, has included 32 children during the first 30 months. Results have been excellent. All children who underwent elective transplantations (n = 18) are still living. Among the 14 patients whose condition required hospitalization before transplantation, 86% have survived. Vascular complications and graft loss due to primary dysfunction or chronic rejection have been reduced, but 22% of the patients have biliary stenosis. In the donors, there has been no severe complication or sequelae. Use of related living donor livers has increased the number of grafts available for children on the waiting list for cadaver livers. The resulting gain in waiting time has also reduced the risk of death before transplantation. In our experience, the combination of the two transplantation programs using living donors and cadaver livers has had a positive impact on global management of children referred for liver transplantation, whatever the option chosen by the parents.