Pediatric Liver and Transplant Surgery: Results of an International Survey and Expert Consensus Recommendations.

Autor: Lemoine CP; Division of Transplant and Advanced Hepatobiliary Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA., Madadi-Sanjani O; Department of Pediatric Surgery, Hannover Medical School, 30625 Hannover, Germany., Petersen C; Department of Pediatric Surgery, Hannover Medical School, 30625 Hannover, Germany., Chardot C; Service de Chirurgie Pédiatrique Viscérale, Hôpital Necker-Enfants Malades, Université de Paris, 75015 Paris, France., de Ville de Goyet J; Department for the Treatment and Study of Pediatric Abdominal Diseases and Abdominal Transplantation, ISMETT, 90127 Palermo, Italy., Superina R; Division of Transplant and Advanced Hepatobiliary Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2023 Apr 30; Vol. 12 (9). Date of Electronic Publication: 2023 Apr 30.
DOI: 10.3390/jcm12093229
Abstrakt: Background: Pediatric liver surgery is a complex and challenging procedure and can be associated with major complications, including mortality. Best practices are not established. The aims of this study were to evaluate surgeons' individual and institutional practices in pediatric liver surgery and make recommendations applicable to the management of children who require liver surgery.
Methods: A web-based survey was developed, focusing on the surgical management of children with liver conditions. It was distributed to 34 pediatric surgery faculty members of the Biliary Atresia and Related Disorders (BARD) consortium and 28 centers of the European Reference Network-Rare Liver. Using the Delphi method, a series of questions was then created to develop ideas about potential future developments in pediatric liver surgery.
Results: The overall survey response rate was 70.6% (24/34), while the response rate for the Delphi questionnaire was 26.5% (9/34). In centers performing pediatric liver surgery, most pediatric subspecialties were present, although pediatric oncology was the least present (79.2%). Nearly all participants surveyed agreed that basic and advanced imaging modalities (including ERCP) should be available in those centers. Most pediatric liver surgeries were performed by pediatric surgeons (69.6%). A majority of participants agreed that centers treating pediatric liver tumors should include a pediatric transplant program (86%) able to perform technical variant grafts and living donor liver transplantation. Fifty-six percent of responders believe pediatric liver transplantation should be performed by specialized pediatric surgeons.
Conclusion: Pediatric liver surgery should be performed by specialized pediatric surgeons and should be centralized in regional centers of excellence where all pediatric subspecialists are present. Pediatric hepatobiliary and transplant training needs to be better promoted amongst pediatric surgery fellows to increase this subspecialized workforce.
Databáze: MEDLINE
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