Survival after reduced-size liver transplantation is dependent on pretransplant status.
Orthotopic liver transplantation (OLT) in children is characterized by unique problems including a shortage of compatible-size donors resulting in long waiting periods, significant deterioration while waiting, and death before transplantation. To improve the chances of obtaining an organ for the sickest patients, reduced-size liver transplantation (RSLT) was offered to all hospital-bound children starting in July 1988. Since then, 68 OLTs were performed in 58 children. Thirty-six RSLTs were done in 30 children (42% of total 86 OLT, 53% since 1988). The mean weight of the RSLT patients was 13.5 +/- 10.4 kg versus 23.8 +/- 21.9 kg in the full-size (FSLT) group (P < .05). Twenty-five of 39 transplants (71.4%) done in children < 10 kg were RSLTs in comparison to only 10 of 47 (21.3%) in patients > 10 kg (P < .0005). Since 1988, 25 of 34 (73.5%) of all transplants in children < 10 kg have been RSLTs. Average donor to recipient weight ratio in the RSLT group was 4.21:1 versus 1.17:1 in the FSLT group (P < .0001). RSLT was done as a primary procedure in 26 patients and as a retransplant in 10. Mean blood product replacement was significantly higher in the RSLT group both intraoperatively (515.7 +/- 490.9 v 177.2 +/- 278.3 mL/kg, P < .005) and during the first 24 hours postoperation (50.5 +/- 81.8 mL/kg v 16.4 +/- 28.5 mL/kg, P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)
Bilik
R
R
Department of Surgery, Hospital for Sick Children, University of Toronto, Ontario, Canada.
Greig
P
P
Langer
B
B
Superina
R A
RA
D000206:Actuarial Analysis; D000293:Adolescent; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality* / Q000706:statistics & numerical data; D009864:Ontario / Q000453:epidemiology; D009929:Organ Size; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D015996:Survival Rate; D014019:Tissue Donors; D014850:Waiting Lists