Researchers from Birmingham, England, investigated the technical aspects and outcome of liver transplantation in neonates and small infants.
Neonates and small infants represent fewer than 5% of pediatric candidates for liver replacement. Most cases present under urgent conditions and receive grafts from large donors.
Surgical techniques must be adapted for adequate graft preparation, vascular reconstruction, and abdominal closure.
The team retrospectively analyzed 15 liver transplantations performed at the Liver Units at the Birmingham Children Hospital and the Queen Elizabeth Hospital, in Birmingham.
Liver transplantation was performed under urgent or highly urgent condition in 13 cases.
| Overall survival rate was 60%.
| Journal of Pediatric Surgery |
Reduced or split liver grafts were used in all cases (median donor to recipient weight ratio = 9), including a monosegmental graft in 2 cases.
In 10 cases, vascular reconstruction was done using a vascular conduit (5, 4, and 1 for artery, portal, and hepatic veins, respectively) and a delayed closure of the abdomen was necessary in 7 children.
Postoperative complications were as follows: thrombosis of hepatic artery (n = 1) or portal vein (n = 1), gastrointestinal hemorrhage (n = 2), intraperitoneal bleeding (n = 1), biliary stricture (n = 2), septicemia (n = 1).
Two infants died of brain damage with a functioning graft. In addition, 1 child underwent retransplant for chronic rejection.
Overall, survival rate was 60% after a median follow-up of 34 months.
The authors concluded that this survival rate compares favorably with older patient groups when case mix is comparable.