Harefuah · 2002
[Expanding the grafts pool for pediatric liver transplantation with segmental grafts from living donor and cadaveric reduced size or split grafts].
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Benhaim M
Аннотация
AIM: To compare short and long-term results of pediatric liver transplantation (LT), utilizing segmental grafts from living donors (LD) vs. cadaveric (CAD) reduced size or split grafts.
METHODS: A retrospective analysis of a single center experience (1993-2000), comparing the surgical outcome, the graft function and the survival rates between these groups.
RESULTS: Of 195 LTs in pediatric recipients (age < 18), 48 (25%) were with LD grafts and 47 (24%) with CAD grafts (reduced size, n = 27, or split, n = 20). The mean age and weight of the LD recipients were 1.8 +/- 3 yrs and 9.0 +/- 8.1 kg vs. 3.5 +/- 4 yrs. and 15.2 +/- 14.5 kg in the CAD group. The distribution of etiologies was comparable (EHBA, 54% vs. 49%; inborn errors in metabolism, 12.5% vs. 12%; acute idiopathic hepatic failure, 12.5% vs. 14.2%). The severity of pretransplant disease and the fraction of acute hepatic failure cases were also comparable, although less LD grafts were used for urgent re-transplantation due to primary non-function or vascular complications (1 case in the LD group vs. 6 in the CAD group). The median warm ischemia time was similar (43 min; range, 28-87 min vs. 45 min; range 12-82 min), but the median cold ischemia time was significantly different (60 min; range 43-298 in LD vs. 637 min; range, 342-1102 in CAD grafts). Both patient and graft survival in 3 months, 1 and 5 years were significantly superior in the LD group (patient survival, 97%, 91% and 89% vs. 82%, 70% and 62%, p < 0.001; graft survival, 92%, 89% and 77% vs. 66%, 59% and 52%, p < 0.005). The incidence of vascular complications (hepatic artery or portal vein thrombosis) and biliary complications (leak of stricture) was comparable (vascular, 10% vs. 7%, biliary, 16% vs. 9%). The incidence of poor early graft function (6% vs. 21%) and primary non-function (2% vs. 18%) was significantly lower in the LD group.
CONCLUSION: Although presenting similar surgical complexity, the outcome of segmental grafts from LD is better than of reduced size or split cadaveric grafts.
METHODS: A retrospective analysis of a single center experience (1993-2000), comparing the surgical outcome, the graft function and the survival rates between these groups.
RESULTS: Of 195 LTs in pediatric recipients (age < 18), 48 (25%) were with LD grafts and 47 (24%) with CAD grafts (reduced size, n = 27, or split, n = 20). The mean age and weight of the LD recipients were 1.8 +/- 3 yrs and 9.0 +/- 8.1 kg vs. 3.5 +/- 4 yrs. and 15.2 +/- 14.5 kg in the CAD group. The distribution of etiologies was comparable (EHBA, 54% vs. 49%; inborn errors in metabolism, 12.5% vs. 12%; acute idiopathic hepatic failure, 12.5% vs. 14.2%). The severity of pretransplant disease and the fraction of acute hepatic failure cases were also comparable, although less LD grafts were used for urgent re-transplantation due to primary non-function or vascular complications (1 case in the LD group vs. 6 in the CAD group). The median warm ischemia time was similar (43 min; range, 28-87 min vs. 45 min; range 12-82 min), but the median cold ischemia time was significantly different (60 min; range 43-298 in LD vs. 637 min; range, 342-1102 in CAD grafts). Both patient and graft survival in 3 months, 1 and 5 years were significantly superior in the LD group (patient survival, 97%, 91% and 89% vs. 82%, 70% and 62%, p < 0.001; graft survival, 92%, 89% and 77% vs. 66%, 59% and 52%, p < 0.005). The incidence of vascular complications (hepatic artery or portal vein thrombosis) and biliary complications (leak of stricture) was comparable (vascular, 10% vs. 7%, biliary, 16% vs. 9%). The incidence of poor early graft function (6% vs. 21%) and primary non-function (2% vs. 18%) was significantly lower in the LD group.
CONCLUSION: Although presenting similar surgical complexity, the outcome of segmental grafts from LD is better than of reduced size or split cadaveric grafts.