Abstract
The development of pediatric liver transplantation is considerably hampered by the dire shortage of small donor organs. This is a very sad situation because in most experienced centers, liver replacement can offer a long-term hope of survival of more than 70% in a growing variety of pediatric liver disorders. The reported experience with 54 reduced-size grafts on a total of 141 transplants performed in 117 children between 1984 and 1988 demonstrates that the technique of reduced-size liver transplantation not only allows long-term survival but, in fact, offers the same survival hope with the same quality of liver function, regardless of the child's age and clinical condition. The prominent feature of our experience with the reduced liver concerns its deliberate use for elective cases. Seventy-seven per cent of the 30 children who electively received a reduced liver were alive 1 year after transplantation, as were 85% of the 62 children who received a full-size graft. There is no difference in the long-term survival rate of patients who received elective grafts, which is in the range of 75% with both techniques.
Full text
PDFImages in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Andrews W. S., Wanek E., Fyock B., Gray S., Benser M. Pediatric liver transplantation: a 3-year experience. J Pediatr Surg. 1989 Jan;24(1):77–82. doi: 10.1016/s0022-3468(89)80306-9. [DOI] [PubMed] [Google Scholar]
- Bax N. M., Vermeire B. M., Dubois N., Madern G., Meradji M., Molenaar J. C. Orthotopic nonauxiliary homotransplantation of part of the liver in dogs. J Pediatr Surg. 1982 Dec;17(6):906–913. doi: 10.1016/s0022-3468(82)80466-1. [DOI] [PubMed] [Google Scholar]
- Bismuth H., Houssin D. Reduced-sized orthotopic liver graft in hepatic transplantation in children. Surgery. 1984 Mar;95(3):367–370. [PubMed] [Google Scholar]
- Broelsch C. E., Emond J. C., Thistlethwaite J. R., Whitington P. F., Zucker A. R., Baker A. L., Aran P. F., Rouch D. A., Lichtor J. L. Liver transplantation, including the concept of reduced-size liver transplants in children. Ann Surg. 1988 Oct;208(4):410–420. doi: 10.1097/00000658-198810000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Burdelski M., Schmidt K., Hoyer P. F., Bernsau U., Galaske R., Brodehl J., Ringe B., Lauchart W., Wonigeit K., Pichlmayr R. Liver transplantation in children: the Hannover experience. Transplant Proc. 1987 Aug;19(4):3277–3281. [PubMed] [Google Scholar]
- Busuttil R. W., Memsic L. D., Quinones-Baldrich W., Hiatt J. R., Ramming K. P. Liver transplantation at UCLA. Program development, organization, initiation, and early results. Am J Surg. 1986 Jul;152(1):75–80. doi: 10.1016/0002-9610(86)90146-7. [DOI] [PubMed] [Google Scholar]
- Esquivel C. O., Koneru B., Karrer F., Todo S., Iwatsuki S., Gordon R. D., Makowka L., Marsh W. J., Jr, Starzl T. E. Liver transplantation before 1 year of age. J Pediatr. 1987 Apr;110(4):545–548. doi: 10.1016/s0022-3476(87)80545-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hiatt J. R., Ament M. E., Berquist W. J., Brems J. F., Brill J. E., Colonna J. O., 2nd, el Khoury G., Quinones W. J., Ramming K. P., Vargas J. H. Pediatric liver transplantation at UCLA. Transplant Proc. 1987 Aug;19(4):3282–3288. [PubMed] [Google Scholar]
- Jenkins R. L. The Boston Center for Liver Transplantation (BCLT). Initial experience of a new surgical consortium. Arch Surg. 1986 Apr;121(4):424–430. doi: 10.1001/archsurg.1986.01400040060009. [DOI] [PubMed] [Google Scholar]
- Kalayoglu M., Stratta R. J., Sollinger H. W., Hoffmann R. M., D'Alessandro A. M., Pirsch J. D., Belzer F. O. Liver transplantation in infants and children. J Pediatr Surg. 1989 Jan;24(1):70–76. doi: 10.1016/s0022-3468(89)80305-7. [DOI] [PubMed] [Google Scholar]
- Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep. 1966 Mar;50(3):163–170. [PubMed] [Google Scholar]
- Otte J. B., Eucher P., Latour J. P., de Ville de Goyet J., Yandza T., de Hemptinne B., Kestens P. J. Liver transplantation for biliary atresia: indications and results. Z Kinderchir. 1988 Apr;43(2):99–105. doi: 10.1055/s-2008-1043426. [DOI] [PubMed] [Google Scholar]
- Otte J. B., Yandza T., Tan K. C., Salizzoni M., de Ville de Goyet J., de Hemptinne B. Recent developments in pediatric liver transplantation. Transplant Proc. 1987 Oct;19(5):4361–4364. [PubMed] [Google Scholar]
- Otte J. B., Yandza T., de Ville de Goyet J., Tan K. C., Salizzoni M., de Hemptinne B. Pediatric liver transplantation: report on 52 patients with a 2-year survival of 86%. J Pediatr Surg. 1988 Mar;23(3):250–253. doi: 10.1016/s0022-3468(88)80733-4. [DOI] [PubMed] [Google Scholar]
- Otte J. B., de Hemptine B., Moulin D., Veyckemans F., Carlier M. A., Buts J. P., Claus D., Reynaert M., de Ville de Goyet J., Rahier J. La transplantation hépatique chez l'enfant. Chir Pediatr. 1985;26(5):261–273. [PubMed] [Google Scholar]
- Otte J. B., de Ville de Goyet J., de Hemptinne B., Kestens P. J., Moulin D., Carlier M. A., Claus D., Rahier J., Buts J. P. Liver transplantation in children: report of 2 1/2 years' experience at the University of Louvain Medical School in Brussels. Transplant Proc. 1987 Aug;19(4):3289–3302. [PubMed] [Google Scholar]
- Ringe B., Pichlmayr R., Burdelski M. A new technique of hepatic vein reconstruction in partial liver transplantation. Transpl Int. 1988 Apr;1(1):30–35. doi: 10.1007/BF00337846. [DOI] [PubMed] [Google Scholar]
- Shaw B. W., Jr, Wood R. P., Kaufman S. S., Williams L., Antonson D. L., Vanderhoof J. Liver transplantation therapy for children: Part 1. J Pediatr Gastroenterol Nutr. 1988 Mar-Apr;7(2):157–166. doi: 10.1097/00005176-198803000-00001. [DOI] [PubMed] [Google Scholar]
- Starzl T. E., Koep L. J., Weil R., 3rd, Lilly J. R., Putnam C. W., Aldrete J. A. Right trisegmentectomy for hepatic neoplasms. Surg Gynecol Obstet. 1980 Feb;150(2):208–214. [PMC free article] [PubMed] [Google Scholar]
- Strong R., Ong T. H., Pillay P., Wall D., Balderson G., Lynch S. A new method of segmental orthotopic liver transplantation in children. Surgery. 1988 Jul;104(1):104–107. [PubMed] [Google Scholar]
- Tan K. C., Yandza T., de Hemptinne B., Clapuyt P., Claus D., Otte J. B. Hepatic artery thrombosis in pediatric liver transplantation. J Pediatr Surg. 1988 Oct;23(10):927–930. doi: 10.1016/s0022-3468(88)80387-7. [DOI] [PubMed] [Google Scholar]
- Tzakis A. G., Gordon R. D., Shaw B. W., Jr, Iwatsuki S., Starzl T. E. Clinical presentation of hepatic artery thrombosis after liver transplantation in the cyclosporine era. Transplantation. 1985 Dec;40(6):667–671. doi: 10.1097/00007890-198512000-00019. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Zitelli B. J., Gartner J. C., Malatack J. J., Urbach A. H., Miller J. W., Williams L., Kirkpatrick B., Breinig M. K., Ho M. Pediatric liver transplantation: patient evaluation and selection, infectious complications, and life-style after transplantation. Transplant Proc. 1987 Aug;19(4):3309–3316. [PubMed] [Google Scholar]
- de Hemptinne B., Salizzoni M., Tan K. C., Otte J. B. The technique of liver size reduction in orthotopic liver transplantation. Transplant Proc. 1988 Feb;20(1 Suppl 1):508–511. [PubMed] [Google Scholar]
- de Hemptinne B., Salizzoni M., Yandza T. C., de Ville de Goyet J., Tan K. C., Kestens P. J., Otte J. B. Indication, technique, and results of liver graft volume reduction before orthotopic transplantation in children. Transplant Proc. 1987 Oct;19(5):3549–3551. [PubMed] [Google Scholar]