Abstract
Introduction
Biliary atresia (BA) is the most frequent disease leading to liver transplantation (LT) in infants. Since the patients often require transplantation before reaching a body weight of 10 kg, it is necessary to perform living-related or split liver transplantation by using a left lateral segment. However, this graft often exceeds a graft body weight ratio (GBWR) of 4. Because of the size mismatch and poor portal venous blood flow in most recipients, temporary abdominal closure is often favoured. The aim of the present study is to investigate the feasibility of primary abdominal closure in this group of extremely small infants undergoing LT.
Patients and methods
All patients with the diagnosis of BA and a body weight ≤10 kg who underwent LT in our centre between January 2004 and December 2014 were included in this study. Patients who received primary abdominal closure at transplantation (group 1) were compared with those receiving temporary abdominal closure (group 2). The postoperative clinical and biochemical course was analysed. The outcome was determined and correlated with body and graft weight and the GBWR.
Results
Sixty-six LTs were performed in 57 patients in the study period (22 male, 35 female). Thirty-six patients received primary closure (group 1). Twenty-eight patients received temporary closure (group 2). Mean age at LT was 10 months (range 3–26) and mean GBWR 4.8 (range 2.9–9.3). A GBWR ≥4 occurred in 61.1 % in group 1 and in 60.9 % in group 2. There was no significant difference between both groups concerning body weight, graft weight or GBWR. Vascular thrombosis occurred in 8 patients (22 %) and 15 patients (42 %) in group 1 and in 10 patients (36 %) and 11 patients (39 %) in group 2, respectively. Six patients (17 %) of group 1 and five patients (18 %) of group 2 developed an intraabdominal infection postoperatively.
After a mean follow-up of 4.6 years (range 1 month–11.1 years), patient and graft survival were 90.1 and 75 % in group 1 and 78.3 and 64.3 % in group 2, respectively.
Conclusion
In our study, primary abdominal closure displays a similar outcome in comparison to temporary abdominal closure.
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References
Broering DC, Kim JS, Mueller T, Fischer L, Ganschow R, Bicak T et al (2004) One hundred thirty-two consecutive pediatric liver transplants without hospital mortality: lessons learned and outlook for the future. Ann Surg 240:1002–1012
Lee S, Park H, Moon SB, Jung SM, Kim JM, Kwon CH et al (2013) Long-term results of biliary atresia in the era of liver transplantation. Pediatr Surg Int 29:1297–1301
Sasaki H, Tanaka H, Wada M, Kazama T, Nishi K, Nakamura M et al (2014) Liver transplantation following the Kasai procedure in treatment of biliary atresia: a single institution analysis. Pediatr Surg Int 30:871–875
Schukfeh N, Lenz V, Metzelder ML, Paul A, Mathe Z, Kathemann S et al (2015) First case studies of successful ABO-incompatible living-related liver transplantation in infants in Germany. Eur J Pediatr Surg 25:77–81
Schukfeh N, Doerner JM (2014) Heintschel von Heinegg E, Steinmann J, Metzelder ML, Kathemann S et al. Spectrum of pathogens in native liver, bile, and blood during pediatric liver transplantation. Pediatr Transplant 18:266–271
Emre S, Umman V (2011) Split liver transplantation: an overview. Transplant Proc 43:884–887
Uribe M, Alba A, Hunter B, González G, Godoy J, Ferrario M et al (2013) Liver transplantation in children weighing less than 10 kg: Chilean experience. Transplant Proc 45:3731–3733
Iglesias J, López JA, Ortega J, Roqueta J, Asensio M, Margarit C et al (2004) Liver transplantation in infants weighing under 7 kilograms: management and outcome of PICU. Pediatr Transplant 8:228–232
Schulze M, Dresske B, Deinzer J, Braun F, Kohl M, Schulz-Jürgensen S et al (2011) Implications for the usage of the left lateral liver graft for infants ≤10 kg, irrespective of a large-for-size situation—are monosegmental grafts redundant? Transpl Int 24:797–804
Broelsch CE, Whitington PF, Emond JC, Heffron TG, Thistlethwaite JR, Stevens L et al (1991) Liver transplantation in children from living related donors. Surgical techniques and results. Ann Surg 214:428–437
Broering DC, Sterneck M, Rogiers X (2003) Living donor liver transplantation. J Hepatol 38:119–135
Hoyer DP, Klein C, Kathemann S, Paul A, Mathé Z et al (2013) Left-lateral living related liver donation—the Essen experience. Zentralbl Chir 21
Kiuchi T, Kasahara M, Uryuhara K, Inomata Y, Uemoto S et al (1999) Impact of graft size mismatching on graft prognosis in liver transplantation from living donors. Transplantation 67:321–327
Ogawa K, Kasahara M, Sakamoto S, Ito T, Taira K, Oike F et al (2007) Living donor liver transplantation with reduced monosegments for neonates and small infants. Transplantation 83:1337–1340
Srinivasan P, Vilca-Melendez H, Muiesan P, Prachalias A, Heaton ND, Rela M (1999) Liver transplantation with monosegments. Surgery 126:10–12
Tannuri AC, Gibelli NE, Ricardi LR, Santos MM, Maksoud-Filho JG, Pinho-Apezzato ML, Silva MM, Velhote MC, Ayoub AA, Andrade WC, Leal AJ, Miyatani HT, Tannuri U (2011) Living related donor liver transplantation in children. Transplant Proc 43:161–164
Vasavada B, Chen CL (2015) Vascular complications in biliary atresia patients undergoing living donor liver transplantation: analysis of 110 patients over 10 years. J Indian Assoc Pediatr Surg 20:121–126
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all individual participants included in the study.
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Schukfeh, N., Holland, AC., Hoyer, D.P. et al. Liver transplantation in infants with biliary atresia: comparison of primary versus temporary abdominal closure. Langenbecks Arch Surg 402, 135–141 (2017). https://doi.org/10.1007/s00423-016-1525-x
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DOI: https://doi.org/10.1007/s00423-016-1525-x