Risk factors for de novo hepatitis B infection in pediatric living donor liver transplantation

AIM: To investigate the incidence of de novo hepatitis B virus (HBV) infection after pediatric living donor liver transplantation (LDLT) and to analyze the risk factors associated with this de novo HBV infection.

Laparoscopic left lateral sectionectomy in pediatric living donor liver transplantation by single-port approach:A case report

BACKGROUND Single-port laparoscopy has been used in a variety of abdominal operations.We report the first case of single-port laparoscopic left lateral sectionectomy in pediatric laparoscopic living donor liver transplantation.CASE SUMMARY A 28-year-old man volunteered for living liver donation to his daughter who was diagnosed with liver cirrhosis and portal hypertension after the Kasai procedure for biliary atresia.His body mass index was 20.5 kg/m2.Liver dynamic computed tomography showed:(1)Left lateral graft volume of 232.76 cm3 with a graft-torecipient weight ratio of 2.59%;and(2)Right hepatic artery derived from the superior mesenteric artery.A single-port access system was placed through a transumbilical incision,including four trocars:two 12-mm ports for a camera and endoscopic stapler and two 5-mm working ports.Liver parenchyma was dissected by a Harmonic and Cavitron Ultrasonic Surgical Aspirator,while bipolar was used for coagulation.The bile duct was transected above the bifurcation by indocyanine green fluorescence cholangiography.The specimen was retrieved from the umbilical incision.The total operation time was 4 h without blood transfusion.The final graft weight was 233.6 g with graft-torecipient weight ratio of 2.60%.The donor was discharged uneventfully on postoperative day 4.CONCLUSION Single-port laparoscopic left lateral sectionectomy is feasible in pediatric laparoscopic living donor liver transplantation in an experienced transplant center.

Comment on pediatric living donor liver transplantation decade progress in Shanghai: Characteristics and risks factors of mortality

Since the first successful liver transplantation was performed five decades ago,pediatric liver transplantation has become the gold standard treatment choice for pediatric liver disease,including metabolic diseases,liver tumors,and some acute liver failure.With improvements in immunosuppression,surgical techniques,and postoperative medical care,long-term outcomes of patients after liver transplantation have markedly improved,especially in pediatric patients.

Pediatric living donor liver transplantation using liver allograft after ex vivo backtable resection of hemangioma: A case report

BACKGROUND Use of liver allograft with hepatic hemangioma after in vivo resection of hemangioma in living donor liver transplantation(LDLT)has been previously reported.However,there are few reports describing ex vivo backtable resection of hemangioma from liver allografts in LDLT.CASE SUMMARY A 55-year-old male was evaluated as a donor for an 8-month-year old patient with acute hepatic failure due to biliary atresia.Pre-operative contrast enhanced computed tomography revealed a 9 cm hemangioma in segment 4 with vascular variations in the donor.During LDLT,an intra-operative intrahepatic cholangiography was performed to ensure no variation in the anatomy of the intrahepatic bile duct.After intra-operative pathological diagnosis,ex vivo backtable resection of the hemangioma was performed and the liver allograft was transplanted into the recipient.The donor’s and recipient’s post-operative course were uneventful.At the 2-year follow-up,the liver allograft showed good regeneration without any recurrence of hemangioma.CONCLUSION Liver allografts with hemangiomas are an acceptable alternative strategy for LDLT.Ex vivo backtable resection of hemangioma from the donor liver during pediatric LDLT is safe and feasible,and can effectively reduce the operative time and intra-operative bleeding for the donor.

Outcomes of Liver Transplantation Using Pediatric Deceased Donor Livers： A Single-Center Analysis of 102 Donors

Background： The outcome of pediatric deceased donor liver transplantation （LT） has not been well studied, especially pediatric deceased donor livers used in adult transplantation. This study aimed to evaluate the efficacy of LT using pediatric deceased donor livers and compare the outcomes between pediatric-to-pediatric LT and pediatric-to-adult LT. Methods： A retrospective review of LT using pediatric deceased donor livers from June 2013 to August 2016 was performed. The patients were divided into the pediatric-to-pediatric LT group and pediatric-to-adult LT group based on the ages of the recipients. The survival and incidence of early vascular complications （VCs） were observed between the two groups. We also analyzed the risk factors of early VCs in pediatric LT and the effect of donor hypernatremia on the prognosis of recipients. Results： There were 102 cases of LT using pediatric deceased donor livers in our hospital from June 2013 to August 2016. 83 pediatric-to-pediatric LT （recipients＇ age ≤13 years） and 19 pediatric-to-adult LT （recipients＇ age≥19 years）. The ratio of early VC was similar in the two groups （19.3% vs. 10.6%, P = 0.514）. Low body weight of recipient was an independent risk factor of early VC in pediatric LT （odds ratio： 0.856, 95% confidence interval： 0.752-0.975, P = 0.019）. The 1-year cumulative survival rates of grafts and patients were 89.16% and 91.57% in pediatric-to-pediatric LT and 89.47% and 94.74% in pediatric-to-adult LT, respectively （all P 〉 0.05）. In all cases. patients using donors with hypernatremia （serum sodium levels ≥ 150mmol/L） had worse graft survival （χ2=4.330, P = 0.037）. Conclusions： Pediatric-to-pediatric LT group has similar graft and patient survival rates with those of pediatric-to-adult LT group. Low body weight of recipients is an independent risk factor of early VC in pediatric LT. Patients using donors with hypernatremia have worse graft survival.

Impact of living donor liver with steatosis and idiopathic portal inflammation on clinical outcomes in pediatric liver transplantation:Beijing experience

Background:To evaluate the impact of steatosis and/or idiopathic portal inflammation(IPI)in living donor livers on recipients’clinical outcomes.Methods:We assessed 305 qualified donor liver samples from June 2013 to December 2018.Donors and recipients’clinical characteristics,including follow-up data were retrieved.The graft and overall survival with/without steatosis or portal inflammation were compared by Kaplan-Meier analysis.Results:For living donors,the medium age of was 31.2(28,35.8)years old;liver histopathology showed macrovesicular steatosis:0-5%264/305(86.6%)and 5-30%41/305(13.4%),IPI:no 220/305(72.1%)and mild 85/305(27.9%).For recipients,the medium age was 1.0(0.6,1.5)years old;the median pediatric-end-stage-liver-disease score was 16(5.0,26.0)and medium follow-up time was 32.8(24.8,52.0)months.Biliary atresia(69.5%)was the main indication for liver transplantation(LT).Conclusions:The presence of steatosis and portal inflammation of the donor liver did not impact the clinical outcomes including transaminase or bilirubin normalization,short-/long-term complications and recipients’survival.However,recipients with high pediatric-end-stage-liver-disease score(>16)receiving donor liver with portal inflammation,but not steatosis,had trend negative effect on recipients’survival.In conclusion,donor livers with mild steatosis and portal inflammation were qualified for pediatric living donor LT.However,donor liver with mild portal inflammation would better not be allocated to recipients with high pediatric-end-stage-liver-disease score.This study provided new evidence in pediatric living donor liver allocation.