200 living donor liver transplantation in children: Outcomes and results according to indication for transplantation and graft type
Javier Serradilla1, Alba Bueno1, Ane Miren Andrés1, Alba Sánchez-Galán1, Jose Luis Encinas1, Javier Nuño2, Loreto Hierro3, Francisco Hernández-Oliveros1,4, Manuel López-Santamaría1.
1Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain; 2General and Transplants Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain; 3Pediatric Hepatology, Hospital Universitario La Paz, Madrid, Spain; 4ERN Transplanchild, IdiPAZ - Hospital Universitario La Paz, Madrid, Spain
Introduction: Living donor liver transplantation (LDLT) is probably the most complex procedure in the field of liver transplantation. Its extensive use results of the shortage of pediatric cadaveric organs and its generally shorter waiting times.
This paper analyze the results, complications and survival of 200 pediatric LDLT according to the used graft type and the indication to perform the transplant.
Materials and Methods: Retrospective study of 200 pediatric cases of LDLT performed between 1993-2019. The indications were divided in biliary atresia (BA: 128 patients, 64%), unresectable liver tumors (ULT: 27, 13.5%), metabolopathies (MET: 17, 8.5%), Alagille syndromes (AS: 11, 5.5 %), familial intrahepatic cholestasis (FIC: 5, 2.5%) and miscellaneous (M: 12, 6%). Grafts were 164 left lateral segments (LLS: segments 2 and 3), 20 extended LLS (ELLS), 14 left hepatic lobes (LHL: segments 2, 3 and 4) and 2 right hepatic lobes (RHL: segments 5, 6, 7 and 8). A comparative study was performed between the diagnostic groups and graft types, considering a p <0.05 value as statistically significant.
Results: Average age and weight of patients were 23 months and 10 kg. No significant differences were observed in grafts’ function (84% [75-92]) nor retransplantation rate (7% [0-15]) according to their indication. Graft and patient survival after 1 and 5 years [graft (87% / 83%), patient (96% / 92%) was also similar.
LLS had a lower rate of graft loss (11% vs 35% ELLS vs 21% LHL vs 100% RHL; p <0.05) and a lower number of complications [biliary complications 16% LLS vs 35% ELLS vs 28% LHL vs 25% RHL (p <0.05); vascular complications 8% LLS vs 30% ELLS vs 14% LHL vs 50% RHL (p <0.05)]. LLS also showed a higher patient and graft survival rate (p <0.05).
Conclusion: BA and ULT remain the best indications for LDLT in children. However, the use of this kind of graft can be extended to the rest of indications as they show the same global prognosis.
LLS is the graft type that brings the best results after LDLT, so its use should be prioritized over other types of grafts.
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