Biological abdominal wall expansion in pediatric liver recipients after transplantation with large-for-size organs.

 

Background After pediatric split liver transplantation intraabdominal loss of domain due to a large-for-size left lateral graft is a frequent problem for fascial closure and potentially leads to reduced liver perfusion and abdominal compartment syndrome. Therefore, delayed fascial closure with use of temporary silastic meshes and reoperation or alternative fascial bridging procedures are necessary.

Methods Between 2019 and 2020 biological meshes were used for abdominal wall expansion in 4 cases of pediatric split liver transplantation. These cases were analyzed retrospectively.

Results 1 male and 3 female children with median age of 6 months (range: 0–8 months) and weight of 6.2kg (range: 3.5–8kg) received a large-for-size left lateral graft. Graft-to-recipient weight ratio (GRWR) was 5.1% (range: 3.7–8.5%) in median. Biologic mesh implantation for abdominal wall expansion, twice each bovine (SurgiMend 3mm, Integra) and sheep matrix (Ovitex 1s and 2s, TELA Bio), was done in median 5 days (range: 3–9 days) after transplantation when signs of abdominal compartment syndrome with portal vein thrombosis in 2 and of the liver artery in 1 case occured. Median follow up was 11.5 months (range: 9–17 months) and showed good liver perfusion by duplex sonography and normal corporal development without signs of ventral hernia. One patient died because of a fulminant graft rejection and emergency re-transplantation 11 months after initial transplantation.

Conclusion Biologic meshes can be used as safe method for abdominal wall expansion to achieve fascial closure in large-for-size children liver transplant recipients. Usage for primary fascial closure can be considered in selected patients.

Publication History

Article published online:
26 January 2022

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