Living Related Donor Liver Transplantation in Children

• Published in: Transplantation proceedings 2011, Vol.43 (1), p.161-164
• Main Authors: Tannuri, A.C.A, Gibelli, N.E.M, Ricardi, L.R.S, Santos, M.M, Maksoud-Filho, J.G, Pinho-Apezzato, M.L, Silva, M.M, Velhote, M.C.P, Ayoub, A.A.R, Andrade, W.C, Leal, A.J, Miyatani, H.T, Tannuri, U
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; Child; Family; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; General aspects; Humans; Immunosuppressive Agents - administration & dosage; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; Living Donors; Male; Medical sciences; Middle Aged; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue, organ and graft immunology
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2010.11.013

Abstract Objective The objective of this study was to report our experience with pediatric orthotopic liver transplantation (OLT) with living related donors. Methods We performed a retrospective chart analysis of 121 living related donor liver transplantations (LRDLT) from June 1998 to June 2010. Results Indications were biliary atresia (BA; n = 81), primary sclerosing cholangitis (n = 5), α-1 antitrypsin deficiency (n = 4); cholestasis (n = 9), fulminant hepatic failure (n = 8), autoimmune hepatitis (n = 2), Alagille syndrome (n = 4), hepatoblastoma (n = 3), tyrosinemia (n = 2), and congenital hepatic fibrosis (n = 3). The age of the recipients ranged from 7–174 months (median, 22) and the weights ranged from 6–58 kg (median, 10). Forty-nine children (40.5%) weighed ≤10 kg. The grafts included the left lateral segment (n = 108), the left lobe (n = 12), and the right lobe (n = 1). The donors included 71 mothers, 45 fathers, 2 uncles, 1 grandmother, 1 grandfather, and 1 sister with a median age of 29 years (range, 16–53 ys) and a median weight of 68 kg (range, 47–106). Sixteen patients (12.9%) required retransplantation, most commonly due to hepatic artery thrombosis (HAT; n = 13; 10.7%). The other complications were biliary stenosis (n = 25; 20.6%), portal vein thrombosis (PVT; n = 11; 9.1%), portal vein stenosis (n = 5; 4.1%), hepatic vein stenosis (n = 6; 4.9%), and lymphoproliferative disorders (n = 8; 6.6%). The ultimate survival rate of recipients was 90.3% after 1 year and 75.8% after 3 years. Causes of early death within 1 month were HAT (n = 6), PVT (n = 2), severe graft dysfunction (n = 1), sepsis (n = 1), and intraoperative death in children with acute liver failure (n = 2). Causes of late deaths included lymphoproliferative disease (n = 3), chronic rejection (n = 2), biliary complications (n = 3), and recurrent disease (n = 3; hepatoblastoma and primary sclerosing cholangitis). Conclusions Despite the heightened possibility of complications (mainly vascular), LRDLT represented a good alternative to transplantation from cadaveric donors in pediatric populations. It was associated with a high survival ratio.