Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2015; 21(23): 7248-7253
Published online Jun 21, 2015. doi: 10.3748/wjg.v21.i23.7248
Living donor liver transplantation with body-weight more or less than 10 kilograms
Sheng-Chun Yang, Chia-Jung Huang, Chao-Long Chen, Chih-Hsien Wang, Shao-Chun Wu, Tsung-Hsiao Shih, Sin-Ei Juang, Ying-En Lee, Bruno Jawan, Yu-Feng Cheng, Kwok-Wai Cheng
Sheng-Chun Yang, Chia-Jung Huang, Chih-Hsien Wang, Shao-Chun Wu, Tsung-Hsiao Shih, Sin-Ei Juang, Ying-En Lee, Bruno Jawan, Kwok-Wai Cheng, Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
Chao-Long Chen, Department of Surgery and Liver Transplant Program, Kaohsiung Chang Gung Memorial and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
Yu-Feng Cheng, Department of Radiology, Kaohsiung Chang Gung Memorial and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
Author contributions: Yang SC, Huang CJ contributed equally to this work as first author, designed, collected, analyzed the data and interpretation, wrote the report; Cheng KW designed, collected, analyzed the data and interpretation, wrote the report; Chen CL, Wang CH, Wu SC, Shih TH, Juang SE, Lee YE, Jawan B and Cheng YF participated in data collection, analysis and data interpretation.
Ethics approval: The study was reviewed and approved by the Institutional Review Board for Human Studies of Chang Gung Memorial Hospital (101-1945B).
Conflict-of-interest: All authors declare no conflict of interest and funding in this work.
Data sharing: Informed consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kwok-Wai Cheng, MD, Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123 Ta-Pei Road, Niao Song, Kaohsiung 83301, Taiwan. kwcheng@ms2.hinet.net
Telephone: +886-77317123 Fax: +886-77318762
Received: January 12, 2015
Peer-review started: January 13, 2015
First decision: March 10, 2015
Revised: March 27, 2015
Accepted: May 4, 2015
Article in press: May 4, 2015
Published online: June 21, 2015
Abstract

AIM: To compare the outcomes of pediatric patients weighing less than or more than 10 kg who underwent liver transplantation.

METHODS: Data for 196 pediatric patients who underwent living donor liver transplantation between June 1994 and February 2011 were reviewed retrospectively. The information for each patient was anonymized and de-identified before analysis. The data included information regarding the pre-transplant conditions, intraoperative fluid replacement and outcomes for each patient. The 196 patients were divided into two groups: those with body weights of less than 10 kg were included in group 1 (G1; n = 101), while those with body weights of more than 10 kg were included in group 2 (G2; n = 95). For each group, the patients’ ages, body weights, heights, pediatric end stage liver disease scores, anesthesia times, and warm and cold ischemic times were analyzed. In addition, between-group comparisons were also made. Mann-Whitney U tests were used to compare all the variables except for complications and survival rates, which were analyzed using χ2 tests and Kaplan-Meier tests, respectively.

RESULTS: The general medical conditions of the G1 patients were worse than those of the G2 patients, as shown by the higher pediatric end stage liver disease scores and poorer Z-scores. In addition, the pre-operative Hb and serum albumin levels were all lower for the G1 patients than for the G2 patients. The G1 patients also had significantly more intraoperative blood loss than the G2 patients. In addition, the intraoperative fluid requirements for the G1 patients, including leukocyte poor red blood cell transfusions, 5% albumin infusions and crystalloid infusions, were significantly higher than those for the G2 patients. The risk of intraoperative portal vein thrombosis was higher for the patients in G1 than for those in G2. However, the one-year survival rates (95.9% and 96.8% for G1 and G2, respectively) and three-year survival rates (94.9% and 94.6% for G1 and G2, respectively) for both groups were similar.

CONCLUSION: Patients weighing less than 10 kg typically have poorer conditions, but their survival rates are comparable to those of children weighing more than 10 kg.

Keywords: Pediatric, Body weight, Pre-transplant condition, Fluid, Living donor liver transplantation, Outcome

Core tip: Although pediatric patients weighing less than 10 kg who underwent living donor liver transplantation usually had worse pre-transplant conditions, more intraoperative bleeding and more portal vein complications, their three-year survival rate was 94%, a rate comparable to that achieved by children weighing more than 10 kg. A prerequisite for achieving these excellent results is good and effective teamwork. Cooperation between surgeons, plastic surgeons, and anesthesiologists in the operating theater is fundamental, but the contributions of radiologists are also critical. Radiologists should be available in the operating room to perform Doppler ultrasounds or place vascular stents, as required.