RESUMO
AIM OF THE STUDY: Living donor liver transplantation (LDLT) is regularly performed in small-sized infants. Computed tomography (CT)-based donor liver volumetry is used to estimate the graft size. The aim of our study was to assess the results of CT liver volumetry and their impact on the clinical outcome after LDLT in extremely small-sized infants. PATIENTS AND METHODS: In this study, we included all patients with a body weight of ≤10 kg who underwent living related liver transplantation at our centre between January 2004 and December 2014. In all cases of LDLT, a preoperative CT scan of the donor liver was performed, and the total liver and graft volumes were calculated. The graft shape was estimated by measuring the ventro-dorsal (thickness), cranio-caudal, and transversal (width) diameter of segment II/III. We assessed the impact of CT donor liver volumetry and other risk factors on the outcome, defined as patient and graft survival. RESULTS: In the study period, a total of 48 living related liver transplantations were performed at our centre in infants ≤10 kg [20 male (42%), 28 female (58%)]. The mean weight was 7.3 kg (range 4.4-10 kg). Among the recipients, 33 (69%) received primary abdominal closure and 15 (31%) had temporary abdominal closure. The patient and graft survival rates were 85% and 81%, respectively. In CT volumetry, the mean estimated graft volume was 255 mL (range 140-485 mL) and the actual measured mean graft weight was 307 g (range 127-463 g). The mean ventro-dorsal diameter of segment II/III was 6.9 cm (range 4.3-11.2 cm), the mean cranio-caudal diameter was 9 cm (range 5-14 cm), and the mean width was 10.5 cm (range 6-14.7 cm). The mean graft-body weight ratio (GBWR) was 4.38% (range 1.41-8.04%). A high graft weight, a GBWR >4%, and a large ventro-dorsal diameter of segment II/III were risk factors for poorer patient survival. CONCLUSION: Preoperative assessment of the graft size is a crucial investigation before LDLT. For extremely small-sized recipients, not only the graft weight but also the graft shape seems to affect the outcome.
RESUMO
INTRODUCTION: Biliary atresia (BA) is the most frequent disease leading to liver transplantation (LT) in infants. Since the patients often require transplantation before reaching a body weight of 10 kg, it is necessary to perform living-related or split liver transplantation by using a left lateral segment. However, this graft often exceeds a graft body weight ratio (GBWR) of 4. Because of the size mismatch and poor portal venous blood flow in most recipients, temporary abdominal closure is often favoured. The aim of the present study is to investigate the feasibility of primary abdominal closure in this group of extremely small infants undergoing LT. PATIENTS AND METHODS: All patients with the diagnosis of BA and a body weight ≤10 kg who underwent LT in our centre between January 2004 and December 2014 were included in this study. Patients who received primary abdominal closure at transplantation (group 1) were compared with those receiving temporary abdominal closure (group 2). The postoperative clinical and biochemical course was analysed. The outcome was determined and correlated with body and graft weight and the GBWR. RESULTS: Sixty-six LTs were performed in 57 patients in the study period (22 male, 35 female). Thirty-six patients received primary closure (group 1). Twenty-eight patients received temporary closure (group 2). Mean age at LT was 10 months (range 3-26) and mean GBWR 4.8 (range 2.9-9.3). A GBWR ≥4 occurred in 61.1 % in group 1 and in 60.9 % in group 2. There was no significant difference between both groups concerning body weight, graft weight or GBWR. Vascular thrombosis occurred in 8 patients (22 %) and 15 patients (42 %) in group 1 and in 10 patients (36 %) and 11 patients (39 %) in group 2, respectively. Six patients (17 %) of group 1 and five patients (18 %) of group 2 developed an intraabdominal infection postoperatively. After a mean follow-up of 4.6 years (range 1 month-11.1 years), patient and graft survival were 90.1 and 75 % in group 1 and 78.3 and 64.3 % in group 2, respectively. CONCLUSION: In our study, primary abdominal closure displays a similar outcome in comparison to temporary abdominal closure.
