title: Vascular reconstruction and complications in living donor liver transplantation in infants weighing less than 6 kilograms: the Kyoto experience.
abstract: Smaller-size infants undergoing living-donor liver transplantation (LDLT) are at increased risks of vascular complications because of their smaller vascular structures in addition to vascular pedicles of insufficient length for reconstruction. Out of 585 child patients transplanted between June 1990 and March 2005, 64 (10%) weighing less than 6 kg underwent 65 LDLTs. Median age and weight were 6.9 months (range: 1-16 months) and 5 kg (range: 2.8-5.9 kg), respectively. Forty-five lateral segment, 12 monosegment, and 8 reduced monosegment grafts were adopted, and median graft-to-recipient weight ratio was 4.4% (range: 2.3-9.7). Outflow obstruction occurred in only 1 patient (1.5%). Portal vein complication occurred in 9 (14%) including 5 with portal vein thrombosis. Hepatic artery thrombosis (HAT) occurred in 5 (7.7%). Patient and graft survivals were 73% and 72% at 1 yr, and 69% and 68% at 5 yr after LDLT, respectively. Thirteen of 22 grafts (58%) lost during the follow-up period occurred within the first 3 months posttransplantation. Overall graft survival in patients with and without portal vein complication was 67% and 65%, respectively (P = 0.54). Overall graft survival in patients with and without HAT was 40% and 67%, respectively. HAT significantly affected graft survival (P = 0.04). In conclusion, our surgical technique for smaller-size recipients resulted in an acceptable rate of vascular complications. Overcoming early posttransplantation complications will further improve outcomes in infantile LDLT.
authors.affiliation: Departments of Transplant Surgery, Kyoto University Hospital, Kyoto, Japan. yasumasa@indigo.plata.or.jp
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Shirouzu
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
authors.forename: Daisuke
authors.initials: D
authors.lastname: Morioka
authors.forename: Seisuke
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Kaoru
authors.initials: K
authors.lastname: Taira
authors.forename: Kenji
authors.initials: K
authors.lastname: Uryuhara
authors.forename: Kohei
authors.initials: K
authors.lastname: Ogawa
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Takada
authors.forename: Hiroto
authors.initials: H
authors.lastname: Egawa
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000714:Anastomosis, Surgical; D001835:Body Weight; D005260:Female; D006085:Graft Survival; D006499:Hepatic Artery / Q000601:surgery; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D007223:Infant; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D011169:Portal Vein / Q000601:surgery; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013927:Thrombosis; D016896:Treatment Outcome