Pretransplantation fetal-maternal microchimerism in pediatric liver transplantation from mother

AIM To investigate the rates of pretransplantation fetalmaternal microchimerism(MC) and its effect on rejection in children receiving maternal liver grafts. METHODS DNA or blood samples before liver transplantation(LT) were available in 45 pediatric patients and their mothers. The presence of pretransplantation MC to non-inherited maternal antigens(NIMAs)(NIMA-MC) in the peripheral blood was tested using nested PCRsingle-strand conformation polymorphism analysis for the human leukocyte antigen(HLA)-DRB1 alleles. NIMA-MC was successfully evaluated in 26 of the 45 children. Among these 45 pediatric LT recipients,23 children(51.1%) received transplants from maternal donors and the other 22 from non-maternal donors.RESULTS Among these 26 children,pretransplantation NIMAMC was detected in 23.1%(n = 6),6.1(range,0.8-14) years after birth. Among the children with a maternal donor,the rate of biopsy-proven cellular rejection(BPCR) was 0% in patients with NIMA-MC positivity(0/3) and those with HLA-DR identity with the mother(0/4),but it was 50% in those with NIMA-MC negativity(5/10). Patients with NIMA-MC positivity or HLA-DR identity with the mother showed significantly lower BPCR rate compared with NIMA-MC-negative patients(0% vs 50%,P = 0.04). NIMA-MC-positive patients tended to show lower BPCR rate compared with NIMAMC-negative patients(P = 0.23). CONCLUSION The presence of pretransplantation NIMA-MC or HLADR identity with the mother could be associated with BPCR-free survival in pediatric recipients of LT from maternal donors.

Right or left hepatectomy: a continuing question in the era of pure laparoscopic donor hepatectomy

We read with great interest the article by Fujiki et al.published in the Annals of Surgery(1),which advocates for the use of a left liver graft with a pure laparoscopic donor hepatectomy(PLDH)approach to reduce the burden on living donors.Minimally invasive techniques,including laparoscopic surgery,have been increasingly adopted in donor hepatectomy for liver transplantation.This reflects a broader trend in various surgical fields to enhance patient outcomes both cosmetically and functionally.Since the first report of a PLDH in the form of a left lateral sectionectomy in 2002(2),this approach has expanded to include full left and full right hepatectomies(3,4).With advancements in laparoscopic instruments and growing experience,PLDH has become a standard practice for left lateral section grafts,as recognized by the most recent international consensus guideline(5).However,PLDH for full left and full right grafts has not yet reached the same level of acceptance.Predominantly performed in Asian countries,PLDH for these grafts highlights differences in donor and recipient characteristics compared to Western countries.Further studies and evidence are required to confirm the safety and feasibility of PLDH for full left and full right grafts on a broader scale.