Is There Still a Need for Living-related Liver Transplantation in Children?
| Autor: | Hansjörg Schäfer, Dieter C. Broering, Rainer Ganschow, Knut Helmke, Eike Achilles, Jong-Sun Kim, Martina Sterneck, M Gundlach, Martin Burdelski, Jacob R. Izbicki, C Hillert, Lutz Fischer, Xavier Rogiers, Lars Mueller |
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| Rok vydání: | 2001 |
| Předmět: |
Male
medicine.medical_specialty Adolescent medicine.medical_treatment Liver transplantation Postoperative Complications Living related liver transplantation Scientific Papers Living Donors medicine Humans Child business.industry Mortality rate Graft Survival Infant Patient survival Time optimal Liver Transplantation Surgery Fatty Liver Survival Rate Transplantation Liver Child Preschool Reperfusion Injury Female Liver function business Immunosuppressive Agents Major hepatectomy |
| Zdroj: | Annals of Surgery. 234:713-722 |
| ISSN: | 0003-4932 |
| DOI: | 10.1097/00000658-200112000-00002 |
| Popis: | Living-related liver transplantation (LRT) and split-liver transplantation (SLT) are surgical strategies that have led to a reduction in the pretransplant death rate in children from 20% to nearly 0%. 1–5 LRT provides a graft of excellent quality by minimizing the cold ischemic time. Primary nonfunction (PNF) after LRT is rare. In addition, this procedure is elective and thus allows flexibility in choosing the optimal time for transplantation with regard to the recipient’s clinical status. Because of these advantages, worldwide long-term results of LRT are equal or even superior to those obtained with cadaveric full-size or reduced-size techniques. The actual 1-year graft and patient survival rate after LRT exceeds 80%. 6–10 The expansion of LRT for adult recipients reflects the great expectations of this procedure despite the higher risks for the donor associated with major hepatectomy. Split-liver transplantation (SLT) is technically comparable to LRT. However, as in other cadaveric procedures, it is theoretically susceptible to potential negative effects resulting from logistical and clinical circumstances related to donor condition, organ transportation, and cold ischemic time. SLT is divided into the ex situ approach, which means back-table division of the flushed and cooled graft under preservation conditions, and the in situ split, which is performed by partitioning the liver within the heart-beating donor before flushing and explantation of the divided organ, thus saving the time needed for back-table partitioning under cold ischemic conditions. 11 Initial reports from split-liver programs from Europe and the United States indicate that SLT has acceptable results, 5,12 although initial results were not as encouraging as after the introduction of LRT. Growing surgical experience has resulted in improved outcomes, comparable to those of cadaveric liver trans-plantation. 11,13–17 Whether LRT should generally be preferred over SLT is a matter of debate. 18 LRT might be recommended as the method of choice in pediatric liver transplantation, arguing that it provides grafts of best quality. However, it carries potential risks for the donor that can be avoided by performing SLT. This led Azoulay et al 16 to state that “given the improving results of split-liver transplantation we believe that, whenever possible, this technique should be offered before living-related liver transplantation.” This study aims at providing objective arguments for the choice of procedure in pediatric liver transplantation. Given this aim, the results after LRT and SLT, with regard to postoperative liver function parameters, complications, and survival rates are compared. This study was performed to answer the following questions: Does SLT provide results equal to LRT? Are there still indications in which the decision in favor of LRT over SLT is justified? |
| Databáze: | OpenAIRE |
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