Perioperative blood transfusion decreases long-term survival in pediatric living donor liver transplantation

BACKGROUND The impact of perioperative blood transfusion on short-and long-term outcomes in pediatric living donor liver transplantation(PLDLT)must still be ascertained,mainly among young children.Clinical and surgical postoperative complications related to perioperative blood transfusion are well described up to three months after adult liver transplantation.AIM To determine whether transfusion is associated with early and late postoperative complications and mortality in small patients undergoing PLDLT.METHODS We evaluated the effects of perioperative transfusion on postoperative complications in recipients up to 20 kg of body weight,submitted to PLDLT.A total of 240 patients were retrospectively allocated into two groups according to postoperative complications:Minor complications(n=109)and major complications(n=131).Multiple logistic regression analysis identified the volume of perioperative packed red blood cells(RBC)transfusion as the only independent risk factor for major postoperative complications.The receiver operating characteristic curve was drawn to identify the optimal volume of the perioperative RBC transfusion related to the presence of major postoperative complications,defining a cutoff point of 27.5 mL/kg.Subsequently,patients were reallocated to a low-volume transfusion group(LTr;n=103,RBC≤27.5 mL/kg)and a high-volume transfusion group(HTr;n=137,RBC>27.5 mL/kg)so that the outcome could be analyzed.RESULTS High-volume transfusion was associated with an increased number of major complications and mortality during hospitalization up to a 10-year follow-up period.During a short-term period,the HTr showed an increase in major infectious,cardiovascular,respiratory,and bleeding complications,with a decrease in rejection complications compared to the LTr.Over a long-term period,the HTr showed an increase in major infectious,cardiovascular,respiratory,and minor neoplastic complications,with a decrease in rejection complications.Additionally,Cox hazard regression found that high-volume RBC transfusion increased the mortality risk by 3.031-fold compared to low-volume transfusion.The Kaplan-Meier survival curves of the studied groups were compared using log-rank tests and the analysis showed significantly decreased graft survival,but with no impact in patient survival related to major complications.On the other hand,there was a significant decrease in both graft and patient survival,with high-volume RBC transfusion.CONCLUSION Transfusion of RBC volume higher than 27.5 mL/kg during the perioperative period is associated with a significant increase in short-and long-term postoperative morbidity and mortality after PLDLT.

Biliary complications after pediatric liver transplantation: Risk factors, diagnosis and management

The expanded indications of partial grafts in pediatric liver transplantation have reduced waiting list mortality. However, a higher morbidity is observed, including an increased rate of biliary complications(BCs). Factors such as the type of graft, the preservation methods applied, the donor characteristics, the type of biliary reconstruction, and the number of bile ducts in the liver graft influences the occurrence of these complications. Bile leaks and strictures comprise the majority of posttransplant BCs. Biliary strictures require a high grade of suspicion, and because most children have a bileoenteric anastomosis, its diagnosis and management rely on percutaneous hepatic cholangiography and percutaneous biliary interventions(PBI). The success rates with PBI range from 70% to 90%. Surgery is reserved for patients who have failed PBI. BCs in children after liver transplantation have a prolonged treatment and are associated with a longer length of stay and higher hospital costs. However, with early diagnosis and aggressive treatment, patient and graft survival are not significantly compromised.

Quality of life,depression and anxiety in potential living liver donors for pediatric recipients:A retrospective single center experience

BACKGROUND Living donor liver transplantation is a safe alternative for patients on a liver transplant list.Donor evaluation goes beyond physical variables to include social,emotional,and ethical aspects.The role of pre-donation sociopsychological evaluation of the donor candidate is as important to the success of the procedure as is the medical assessment.Success implies recovery from the operation and pro-mpt engagement in pre-transplant professional and social activities,without leading to psychological or physical distress.Psychological profiling of potential living liver donors(PLLD)and evaluation of quality of life(QOL)can influence outcomes.AIM To evaluate the socio-demographics and psychological aspects(QOL,depression,and anxiety)of PLLD for pediatric liver transplantation in a cohort of 250 patients.METHODS This was a retrospective cohort study of 250 PLLD who underwent psychological pre-donation evaluation between 2015 and 2019.All the recipients were children.The Beck anxiety inventory,Beck depression inventory,and 36-item short-form health survey(SF-36)scores were used to evaluate anxiety(Beck anxiety inventory),depression(Beck depression inventory),and QOL,respectively.RESULTS A total of 250 PLLD were evaluated.Most of them were women(54.4%),and the mean age was 29.2±7.2 years.A total of 120(48.8%)PLLD were employed at the time of evaluation for donation;however,most had low income(57%earned<2 times the minimum wage).A total of 110 patients(44%)did not finish the donation process,and 247 PLLD answered a questionnaire to evaluate depression,anxiety,and QOL(SF-36).Prevalence of depression was of 5.2%and anxiety 3.6%.Although most of the PLLD were optimistic regarding the donation process and never had doubts about becoming a donor,some traces of ambivalence were observed:46%of the respondents said they would feel relieved if a deceased donor became available.CONCLUSION PLLD had a low prevalence of anxiety and depression.The foundation for effective and satisfactory results can be found in the pre-transplantation process,during which evaluations must follow rigorous criteria to mitigate potential harm in the future.Pre-donation psychological evaluation plays a predictive role in post-donation emotional responses and mental health issues.The impact of such findings on the donation process and outcomes needs to be further investigated.