Advertisement

The impact of low recipient weight [≤ 7kg] on long-term outcomes in 1078 pediatric living donor liver transplantations

  • João Seda Neto
    Correspondence
    Corresponding author.
    Affiliations
    Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil

    Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil

    Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil
    Search for articles by this author
  • Paulo Chapchap
    Affiliations
    Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil
    Search for articles by this author
  • Flavia H. Feier
    Affiliations
    Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil

    Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
    Search for articles by this author
  • Renata Pugliese
    Affiliations
    Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil

    Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil

    Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil
    Search for articles by this author
  • Rodrigo Vincenzi
    Affiliations
    Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil

    Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil

    Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil
    Search for articles by this author
  • Marcel R Benavides
    Affiliations
    Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil

    Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil

    Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil
    Search for articles by this author
  • Karina Roda
    Affiliations
    Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil

    Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil

    Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil
    Search for articles by this author
  • Mário Kondo
    Affiliations
    Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil
    Search for articles by this author
  • Eduardo A. Fonseca
    Affiliations
    Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil

    Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil

    Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil
    Search for articles by this author

      Highlights

      • What is currently known about this topic?  Pediatric living donor liver transplantation (PLDLT) in infants and small children is a challenging procedure and requires particular technical refinements. Early vascular complications are still the main cause of patient and graft loss, especially in low body weight recipients, and centers responsible for the care of such patients utilize different strategies to mitigate the problem and achieve better outcomes. .
      • What new information is contained in this article? This paper analyzes the PLDLT outcomes in children with low body weight (<7 kg). It represents the largest population of PLDLT reported so far. With proper management and different technical strategies to avoid “large-for-size syndrome”, that can increase the occurrence of early vascular complications, the long-term survival of small babies was similar to the group of patients with higher body weight. This series shows that, even challenging, PLDLT in small babies is feasible, with good outcomes.

      Abstract

      Background

      infants who require liver transplantation represent a treatment challenge because chronic liver disease at this early age affects the child's growth and development during a critical phase. The aim is to compare demographics, operative data, and long-term outcomes according to recipient weight at the time of LDLT.

      Methods

      This retrospective study included primary LDLT analyzed in 2 groups: BW ≤ 7 kg (n = 322) and BW > 7 kg (n = 756). A historical comparison between periods was also investigated.

      Results

      BW ≤ 7 kg had significantly lower height/age and weight/age z-scores, with median PELD score of 19. Transfusion rates were higher in the BW ≤ 7 kg group (30.9 ml/kg versus 15.5 ml/kg, P < 0.001). Higher frequencies of PV complications were seen in the BW ≤ 7 kg cohort. HAT and retransplantation rates were similar. Those with BW ≤ 7 kg required longer ICU and hospital stays. Patient and graft survival were similar. Patient survival in BW≤ 7 kg was significantly better in the most recent period.

      Conclusion

      Malnutrition and advanced liver disease were more frequent in BW ≤ 7 kg. Despite increased rates of PVT and longer hospital stay, patient and graft long-term survival were similar between groups.

      Keywords

      Abbreviations:

      BA (biliary atresia), BL (biliary leak), BS (biliary stricture), BW (body weight), CIT (cold ischemic time), DDLT (deceased donor liver transplantation), EPVT (early portal vein thrombosis), GRWR (graft-to-recipient weight ratio), HA (hepatic artery), HAT (hepatic artery thrombosis), HG (hyper-reduced grafts), HV (hepatic veins), HVOO (hepatic vein outflow obstruction), IJV (internal jugular vein), IMV (inferior mesenteric vein), INR (international normalized ratio), LDLT (living donor liver transplantation), LGV (left gonadal vein), LL (left lobe), LL+C (left lobe with caudate lobe), LLS (left lateral segment), LPVT (late portal vein thrombosis), LT (liver transplantation), MELD (model for end-stage liver disease), MRI (magnetic resonance imaging), MT (massive transfusion), NA (not available), PELD (pediatric end-stage liver disease), PLDLT (pediatric living donor liver transplantation), POD (post-operative day), PRBCT (packed red blood cell transfusion), PV (portal vein), RL (right lobe), TIT (total ischemic time), VG (vascular grafts), WIT (warm ischemic time)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Vilca-Melendez H.
        • Heaton N.D.
        Paediatric liver transplantation: the surgical view.
        Postgrad Med J. Oct 2004; 80: 571-576https://doi.org/10.1136/pgmj.2003.018598
        • Jimenez-Rivera C.
        • Nightingale S.
        • Benchimol E.I.
        • Mazariegos G.V.
        • Ng V.L.
        Outcomes in infants listed for liver transplantation: a retrospective cohort study using the United Network for Organ Sharing database.
        Pediatr Transpl. Nov 2016; 20: 904-911https://doi.org/10.1111/petr.12756
        • Barshes N.R.
        • Lee T.C.
        • Balkrishnan R.
        • Karpen S.J.
        • Carter B.A.
        • Goss J.A.
        Orthotopic liver transplantation for biliary atresia: the U.S. experience.
        Liver Transpl. Oct 2005; 11: 1193-1200https://doi.org/10.1002/lt.20509
        • Alexopoulos S.P.
        • Merrill M.
        • Kin C.
        • et al.
        The impact of hepatic portoenterostomy on liver transplantation for the treatment of biliary atresia: early failure adversely affects outcome.
        Pediatr Transpl. Jun 2012; 16: 373-378https://doi.org/10.1111/j.1399-3046.2012.01677.x
        • Neto J.S.
        • Feier F.H.
        • Bierrenbach A.L.
        • et al.
        Impact of Kasai portoenterostomy on liver transplantation outcomes: a retrospective cohort study of 347 children with biliary atresia.
        Liver Transpl. Jul 2015; 21: 922-927https://doi.org/10.1002/lt.24132
        • Boster J.M.
        • Browne L.P.
        • Pan Z.
        • Zhou W.
        • Ehrlich P.F.
        • Sundaram S.S.
        Higher mortality in pediatric liver transplant candidates with sarcopenia.
        Liver Transpl. Feb 23 2021; https://doi.org/10.1002/lt.26027
        • Jitwongwai S.
        • Lertudomphonwanit C.
        • Junhasavasdikul T.
        • et al.
        Low psoas muscle index as an unfavorable factor in children with end-stage liver disease undergoing liver transplantation.
        Pediatr Transpl. Mar 18 2021; : e13996https://doi.org/10.1111/petr.13996
        • Taylor S.A.
        • Venkat V.
        • Arnon R.
        • et al.
        Improved outcomes for liver transplantation in patients with biliary atresia since pediatric end-stage liver disease implementation: analysis of the society of pediatric liver transplantation registry.
        J Pediatr. Apr 2020; 219: 89-97https://doi.org/10.1016/j.jpeds.2019.12.023
        • Seda-Neto J.
        • Godoy A.L.
        • Carone E.
        • et al.
        Left lateral segmentectomy for pediatric live-donor liver transplantation: special attention to segment IV complications.
        Transplantation. Sep 15 2008; 86: 697-701https://doi.org/10.1097/TP.0b013e318183ed22
        • Candido H.L.
        • da Fonseca E.A.
        • Feier F.H.
        • et al.
        Risk factors associated with increased morbidity in living liver donation.
        J Transplant. 2015; 2015949674https://doi.org/10.1155/2015/949674
        • Neto J.S.
        • Pugliese R.
        • Fonseca E.A.
        • et al.
        Four hundred thirty consecutive pediatric living donor liver transplants: variables associated with posttransplant patient and graft survival.
        Liver Transpl. May 2012; 18: 577-584https://doi.org/10.1002/lt.23393
        • Neuberger J.
        An update on liver transplantation: a critical review.
        J Autoimmun. Jan 2016; 66: 51-59https://doi.org/10.1016/j.jaut.2015.08.021
        • Jadlowiec C.C.
        • Taner T.
        Liver transplantation: current status and challenges.
        World J Gastroenterol. May 14 2016,; 22: 4438-4445https://doi.org/10.3748/wjg.v22.i18.4438
        • Bondec A.
        • Bucuvalas J.
        The tip of the iceberg: outcomes after liver transplantation for very young infants.
        Pediatr Transpl. Nov 2016; 20: 880-881https://doi.org/10.1111/petr.12809
        • Lu Y.G.
        • Pan Z.Y.
        • Zhang S.
        • et al.
        Living donor liver transplantation in children: perioperative risk factors and a nomogram for prediction of survival.
        Transplantation. Aug 2020; 104: 1619-1626https://doi.org/10.1097/TP.0000000000003056
        • Neto J.S.
        • Fonseca E.A.
        • Vincenzi R.
        • et al.
        Technical choices in pediatric living donor liver transplantation: the path to reduce vascular complications and improve survival.
        Liver Transpl. Dec 2020; 26: 1644-1651https://doi.org/10.1002/lt.25875
        • Venick R.S.
        • Farmer D.G.
        • Soto J.R.
        • et al.
        One thousand pediatric liver transplants during thirty years: lessons learned.
        J Am Coll Surg. Apr 2018; 226: 355-366https://doi.org/10.1016/j.jamcollsurg.2017.12.042
        • Kim W.R.
        • Lake J.R.
        • Smith J.M.
        • et al.
        OPTN/SRTR 2015 annual data report: liver.
        Am J Transpl. Jan 2017; 17: 174-251https://doi.org/10.1111/ajt.14126
        • Grabhorn E.
        • Schulz A.
        • Helmke K.
        • et al.
        Short- and long-term results of liver transplantation in infants aged less than 6 months.
        Transplantation. Jul 27 2004; 78: 235-241https://doi.org/10.1097/01.tp.0000128189.54868.18
        • Tiao G.M.
        • Alonso M.
        • Bezerra J.
        • et al.
        Liver transplantation in children younger than 1 year–the Cincinnati experience.
        J Pediatr Surg. Jan 2005; 40: 268-273https://doi.org/10.1016/j.jpedsurg.2004.09.021
        • Jain A.K.
        • Anand R.
        • Lerret S.
        • et al.
        Outcomes following liver transplantation in young infants: data from the SPLIT registry.
        Am J Transplant. Mar 2021; 21: 1113-1127https://doi.org/10.1111/ajt.16236
        • Venick R.S.
        • Farmer D.G.
        • McDiarmid S.V.
        • et al.
        Predictors of survival following liver transplantation in infants: a single-center analysis of more than 200 cases.
        Transplantation. Mar 15 2010; 89: 600-605https://doi.org/10.1097/TP.0b013e3181c5cdc1
        • Sundaram S.S.
        • Alonso E.M.
        • Anand R.
        Study of pediatric liver transplantation research G. Outcomes after liver transplantation in young infants.
        J Pediatr Gastroenterol Nutr. Oct 2008; 47: 486-492https://doi.org/10.1097/MPG.0b013e318175d7d2
        • Yamamoto H.
        • Khorsandi S.E.
        • Cortes-Cerisuelo M.
        • et al.
        Outcomes of liver transplantation in small infants.
        Liver Transpl. Oct 2019; 25: 1561-1570https://doi.org/10.1002/lt.25619
        • Ziogas I.A.
        • Ye F.
        • Zhao Z.
        • et al.
        Mortality determinants in children with biliary atresia awaiting liver transplantation.
        J Pediatr. Jan 2021; 228: 177-182https://doi.org/10.1016/j.jpeds.2020.09.005
        • Pugliese R.
        • Fonseca E.A.
        • Porta G.
        • et al.
        Ascites and serum sodium are markers of increased waiting list mortality in children with chronic liver failure.
        Hepatology. May 2014; 59: 1964-1971https://doi.org/10.1002/hep.26776
        • Yagi T.
        • Takagi K.
        • Umeda Y.
        • et al.
        Prognostic factors for pediatric living donor liver transplantation: impact of zero-mortality transplant for cholestatic diseases.
        Acta Med Okayama. Dec 2018; 72: 567-576https://doi.org/10.18926/AMO/56374
        • Villarreal J.A.
        • Yoeli D.
        • Ackah R.L.
        • et al.
        Intraoperative blood loss and transfusion during primary pediatric liver transplantation: a single-center experience.
        Pediatr Transpl. Jun 2019; 23: e13449https://doi.org/10.1111/petr.13449
        • Ulukaya S.
        • Acar L.
        • Ayanoglu H.O
        Transfusion requirements during cadaveric and living donor pediatric liver transplantation.
        Pediatr Transpl. Jun 2005; 9: 332-337https://doi.org/10.1111/j.1399-3046.2005.00284.x
        • Hernandez-Cano A.M.
        • Geis J.R.
        • Rumack C.H.
        • Stellin G.P.
        • Lilly J.R.
        Portal vein dynamics in biliary atresia.
        J Pediatr Surg. Jun 1987; 22: 519-521https://doi.org/10.1016/s0022-3468(87)80211-7