Techniques for and outcome of liver transplantation in neonates and infants weighing up to 5 kilograms.
BACKGROUND
Neonates and small infants represent less than 5% of paediatric candidates for liver replacement. Most cases present under urgent conditions and receive grafts from large donors. Surgical techniques must be adapted for adequate graft preparation, vascular reconstruction, and abdominal closure.


METHODS
Technical aspects and outcome of 15 liver transplantations in infants weighing less than 5 kg performed at our unit were analysed retrospectively.


RESULTS
Liver transplantation was performed under urgent or highly urgent condition in 13 cases. Reduced or split liver grafts were used in all cases (median donor to recipient weight ratio, 9), including a monosegmental graft in 2 cases. In 10 cases, vascular reconstruction was done using a vascular conduit (5, 4, and 1 for artery, portal, and hepatic veins, respectively) and a delayed closure of the abdomen was necessary in 7 children. Postoperative complications were as follows: thrombosis of hepatic artery (n = 1) or portal vein (n = 1), gastrointestinal haemorrhage (n = 2), intraperitoneal bleeding (n = 1), biliary stricture (n = 2), septicaemia (n = 1). Two infants died of brain damage with a functioning graft. One child underwent retransplant for chronic rejection.


CONCLUSIONS
Overall, survival rate is 60% (median follow-up, 34 months), which compares favourably with older patient groups when case mix is comparable.
Noujaim
H M
HM
Birmingham, England.
Mayer
D A
DA
Buckles
J A
JA
Beath
S V
SV
Kelly
D A
DA
McKiernan
P J
PJ
Mirza
D F
DF
de Ville De Goyet
J
J
D000367:Age Factors; D001835:Body Weight; D003953:Diagnosis-Related Groups; D006084:Graft Rejection; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008099:Liver / Q000601:surgery; D008107:Liver Diseases / Q000601:surgery; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D021962:Membrane Microdomains; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome