Four hundred thirty consecutive pediatric living donor liver transplants: Variables associated with posttransplant patient and graft survival
| Autor: | Irene K. Miura, Hsiang Teng, Vincenzo Pugliese, Eduardo Carone, Bernardo Ketzer, Francisco Cesar Carnevale, Helry L. Candido, Eduardo A. Fonseca, Teresa Guimarães, Alberto B. Stein, Adriana Porta, Paulo Chapchap, Renata Pugliese, Marcel Benavides, Mário M. Kondo, Gilda Porta, Joao Seda Neto, Rodrigo Vincenzi, Vera Baggio, Celso Arrais Rodrigues |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male medicine.medical_specialty Multivariate analysis Adolescent Bilirubin medicine.medical_treatment Liver transplantation chemistry.chemical_compound Liver disease Hepatic Artery Ascites Living Donors medicine Humans Venous Thrombosis Transplantation Univariate analysis Hepatology Portal Vein business.industry Body Weight Graft Survival Thrombosis Perioperative Middle Aged medicine.disease Liver Transplantation Surgery Portal vein thrombosis chemistry Multivariate Analysis Female medicine.symptom business |
| Zdroj: | Liver Transplantation. 18:577-584 |
| ISSN: | 1527-6465 |
| Popis: | The availability of living donors allows transplant teams to indicate living donor liver transplantation (LDLT) early in the course of liver disease before the occurrence of life-threatening complications. Late referral to transplant centers is still a problem and can compromise the success of the procedure. The aim of this study was to examine the perioperative factors associated with patient and graft survival for 430 consecutive pediatric LDLT procedures at Sirio-Libanes Hospital/A. C. Camargo Hospital (Sao Paulo, Brazil) between October 1995 and April 2011. The studied pretransplant variables included the following: recipient age and body weight, Pediatric End-Stage Liver Disease score, z score for height/age, bilirubin, albumin, international normalized ratio, hemoglobin, sodium, presence of ascites, and previous surgery. The analyzed technical aspects included the graft-to-recipient weight ratio and the use of vascular grafts for portal vein reconstruction. In addition, the occurrence of hepatic artery thrombosis (HAT), portal vein thrombosis (PVT), and biliary complications was also analyzed. The liver grafts included 348 left lateral segments, 5 monosegments, 51 left lobes, and 9 right lobes. In a univariate analysis, an age < 12 months, a low body weight (≤10 kg), malnutrition, hyperbilirubinemia, and HAT were associated with decreased patient and graft survival after LDLT. In a multivariate analysis, a body weight ≤ 10 kg and HAT were significantly associated with decreased patient and graft survival. The use of vascular grafts significantly increased the occurrence of PVT. In conclusion, a low body weight (≤10 kg) and the occurrence of HAT independently determined worse patient and graft survival in this large cohort of pediatric LDLT patients. Liver Transpl, 2012. © 2012 AASLD. |
| Databáze: | OpenAIRE |
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