Segmental liver transplantation from non-heart beating donors--an early experience with implications for the future.
We report our experience of pediatric liver transplantation with partial grafts from non-heart beating donors (NHBD). Controlled donors less than 40 years of age with a warm ischemia time (WI) of less than 30 min were considered for pediatric recipients. Death was declared 5 min after asystole. A super-rapid recovery technique with aortic and portal perfusion was utilized. Mean donor age was 29 years and WI 14.6 min (range 11-18). Seven children, mean age 4.9 years (0.7-11), median weight 20 kg (8.4-53) received NHBD segmental liver grafts. Diagnoses included seronegative hepatitis, neonatal sclerosing cholangitis, familial intrahepatic cholestasis, hepatoblastoma, primary hyperoxaluria and factor VII deficiency (n=2). The grafts included four reduced and one split left lateral segments, one left lobe and one right auxiliary graft. Mean cold ischemia was 7.3 h (6.2-8.8). Complications included one pleural effusion and one biliary collection drained percutaneously. At 20 months (10-36) follow-up all children are alive and well with functioning grafts. Donation after cardiac death is a significant source of liver grafts for adults and children with careful donor selection and short cold ischemic times.
Muiesan
P
P
Liver Transplant Surgical Services, Institute of Liver Studies, King's College Hospital, London, UK. paolo.muiesan@kingsch.nhs.uk
Jassem
W
W
Girlanda
R
R
Steinberg
R
R
Vilca-Melendez
H
H
Mieli-Vergani
G
G
Dhawan
A
A
Rela
M
M
Heaton
N
N
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006323:Heart Arrest; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D007223:Infant; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods