Pediatric living donor liver transplantation: A single center experiences

Yıl 2019, , 285 - 287, 28.04.2019

Gökhan Ertuğrul , Burcu Hızarcı

https://doi.org/10.28982/josam.542279

Öz

Aim: The only definitive treatment of chronic liver disease (cholestatic, metabolic, autoimmune), acute liver failure and liver tumors are liver transplantation in pediatric patients. The aim of this study was to present the experience of our center on pediatric living donor liver transplantation and review of the literature.

Methods: This is retrospective cohort study. Pediatric patients who receive living donor liver transplantation between December 2014 and December 2017 included in the study. Demographic features, complications after transplantation, and mortality rates were recorded.

Results: A total 29 patients were included in the study. Mean age of cases were 3.1 (1-13) years, 18 (62.1%) of the patients were male. Mean Pediatric End-Stage Liver Disease (PELD) scores were 15.6 (-6-37). Mean follow-up period was 60 months. Complication was detected in 11 patients (37.9%) and 5 patients died (mortality rate: 17.9%). In our study, the causes of death were disseminated intravascular coagulation in three patients and sepsis due to biliary leakage in two patients. 

Conclusion: Complications and mortality rates related to pediatric patients with donor liver transplantation in our center are consistent with the literature.

Anahtar Kelimeler

Pediatric patient, Living donor liver transplantation

Pediatrik canlı vericili karaciğer nakli: Tek merkez deneyimi

Öz

Amaç: Kronik karaciğer hastalığının (kolestatik, metabolik, otoimmün), akut karaciğer yetmezliği ve karaciğer tümörlerinin pediatrik hastalarda ekin tek tedavisi karaciğer naklidir Bu çalışmanın amacı merkezimizde yapılan pediatrik canlı vericili karaciğer nakillerini değerlendirmek ve literatürü tartışmaktır.

Yöntemler: Bu çalışma retrospektif kohort çalışmadır. Çalışmaya Aralık 2014 ile Aralık 2017 tarihleri arasında canlı vericili karaciğer nakli yapılan pediatrik hastalar alındı. Demografik özellikler, nakil sonrası komplikasyonlar ve mortalite oranları kaydedildi.

Bulgular: Çalışmaya toplam 29 hasta dahil edildi. Hastaların yaş ortalaması 3,1 (1-13) yıl, 18'i (%62,1) erkekti. Hastaların ortalama Pediatrik Son Dönem Karaciğer Hastalığı (PELD) skorları 15,6 (-6-37) idi. Ortalama takip süresi 60 aydı. Komplikasyon oranı %37,9 (11 hasta) ve mortalite oranı %17,9 (5 hasta) olarak saptandı. Çalışmamızda hastalarımızın ölüm nedeni dissemine intravasküler koagülasyon ve safra kaçağına bağlı sepsis idi.

Sonuç: Merkezimizde pediatrik hastalara yapılan canlı vericili karaciğer nakillerinin komplikasyon ve mortalite oranları literatür ile uyumludur.

Anahtar Kelimeler

Pediatrik hasta, Canlı vericili karaciğer nakli

Kaynakça

• 1. Starzl TE, Marchioro TL, Vonkaulla KN, Hermann G, Brittain RS, Waddell WR. Homotransplantation of the liver in humans. Surg Gynecol Obstet. 1963;117:659–76.
• 2. Larosa C, Baluarte HJ, Meyers KE. Outcomes in pediatric solid organ transplantation. Pediatr Transplant. 2011;15:128–41.
• 3. Tiao G, Ryckman FC. Pediatric liver transplantation. Clin Liver Dis. 2006;10:169–97.
• 4. Otte JB. Pediatric liver transplantation: personal perspectives on historical achievements and future challenges. Liver Transpl. 2016;22:1284–94.
• 5. Squires RH, Ng V, Romero R, Ekong U, Hardikar W, Emre S, et al. Evaluation of the pediatric patient for liver transplantation: 2014 practice guideline by the American Association for the Study of Liver Diseases, American Society of Transplantation and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Hepatology. 2014;60:362–98.
• 6. Tiao G.Liver transplantation. In: Maritz R GA, Ziegler M, Von Allmen Daniel, Weber Thomas R, editors. Operative Pediatric Surgery. 2014;1:1397.
• 7. Yazigi NA. Long term outcomes after pediatric liver transplantation. Pediatr Gastro enterol Hepatol Nutr. 2013;16:207–18.
• 8. Sundaram SS, Mack CL, Feldman AG, Sokol RJ. Biliary atresia: Indications and timing of liver transplantation and optimization of pretransplant care. Liver Transpl. 2017;23:96–109.
• 9. Davenport M, Ong E, Sharif K, Alizai N, McClean P, Hadzic N, et al.Biliary atresia in England and Wales: results of centralization and new bench mark. J Pediatr Surg. 2011;46:1689–94.
• 10. Rajanayagam J,Coman D,Cartwright D,Lewindon PJ. Pediatric acute liver failure: etiology, outcomes, and the role of serial pediatric end-stage liver disease scores. Pediatr Transplant. 2013;17:362–8.
• 11. Kerr DN, Harrison CV, Sherlock S, Walker RM. Congenital hepatic fibrosis. Q J Med. 1961;30:91–117.
• 12. Shorbagi A, Bayraktar Y. Experience of a single center with congenital hepatic fibrosis: a review of the literature. World J Gastroenterol. 2010;16:683–90.
• 13. Arnon R, Annunziato R, Schiano T, Miloh T, Baisley M, Sogawa H, et al. Orthotopic liver transplantation for adults with Alagillesyndrome. Clin Transplant. 2012;26:94–100.
• 14. Mehl A, Bohorquez H, Serrano MS, Galliano G, Reichman TW. Liver transplantation and the management of progressive familial intrahepatic cholestasis in children. World J Transplant. 2016;6:278–90.
• 15. Oishi K, Arnon R, Wasserstein MP, Diaz GA. Liver transplantation for pediatric inherited metabolic disorders: Considerations for indications,complications,and perioperative management. Pediatr Transplant. 2016;20:756–69.
• 16. Brown J, Perilongo G, Shafford E, Keeling J, Pritchard J, Brock P, et al. Pretreatment prognostic factors for children with hepatoblastoma results from the International Society of Paediatric Oncology (SIOP) study SIOPEL1. Eur J Cancer. 2000;36:1418–25.
• 17. D'Alessandro AM, Ploeg RJ, Knechtle SJ, Pirsch JD, Stegall MD, Hoffmann R, et al. Retransplantation of the liver—A seven-year experience. Transplantation. 1993;55:1083-7.
• 18. Shackleton CR, Goss JA, Swenson K, Colquhoun SD, Seu P, Kinkhabwala MM, et al. The impact of microsurgical hepatic arterial reconstruction on the outcome of liver transplantation for congenital biliary atresia. Am J Surg. 1997;173:431-5.
• 19. Bucuvalas J. Long term outcomes in pediatric liver transplantation. Liver Transpl. 2009;15:6–11.
• 20. Ng VL, Fecteau A, Shepherd R, Magee J, Bucuvalas J, Alonso E, et al. Outcomes of 5-year survivors of pediatric liver transplantation: Report on 461 children from a North American multicenter registry. Pediatrics. 2008;122:1128–35.
• 21. Allamneni C, Kyanam Kabir Baig K, Gray S, Peter S. Bleeding at Roux-en Y jejunojejunal anastomosis after orthotopic liver transplantation. VideoGIE. 2018 May 2;3:179-80.
• 22. Kim JM, Kim KM, Yi NJ, Choe YH, Kim MS, Suh KS, et al. Pediatric liver transplantation outcomes in Korea. J Korean Med Sci. 2013 Jan;28(1):42-7. doi: 10.3346/jkms.2013.28.1.42.