[Graft reduction in pediatric hepatic transplantation: value, technique and results].
The benefit of liver transplantation in children with end-stage liver disease is now well established. A few years ago, the scarcity of suitable pediatric donors was responsible for death in 30 to 50% of children on the waiting list and most of them died before the age of 3 years. Since 1981, the use of reduced-size graft in pediatric liver transplantation allowed a dramatic decrease of the pretransplant mortality rate which is now 2 to 14%. The choice of the reduction technique is based on two parameters; the first one is the donor recipient body weight ratio, the second one is the intra-operative measurement of the recipient's internal transverse basithoracic distance. Nowadays, 30 to 50% of the children undergoing a liver transplant, receive a reduced-size graft. The results of reduced-size orthotopic liver transplantation are comparable with full-size orthotopic liver transplantation; the one-year survival rate is 70 to 85%. These results justify the continued use of reduced-size liver transplantation in children with end-stage liver disease. Transplantation of two patients with one liver (bipartition) and liver transplantation from living related donor, which represents an improvement of the reduction technique, was recently performed successfully and may become a useful concept in pediatric liver transplantation.
Boillot
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Service de chirurgie de la transplantation, hôpital Edouard-Herriot, Lyon, France.
D000367:Age Factors; D002648:Child; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008107:Liver Diseases / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D009929:Organ Size
Réduction du greffon en transplantation hépatique pédiatrique: intérêt, technique et résultats.