title: Four hundred thirty consecutive pediatric living donor liver transplants: variables associated with posttransplant patient and graft survival.
abstract: The availability of living donors allows transplant teams to indicate living donor liver transplantation (LDLT) early in the course of liver disease before the occurrence of life-threatening complications. Late referral to transplant centers is still a problem and can compromise the success of the procedure. The aim of this study was to examine the perioperative factors associated with patient and graft survival for 430 consecutive pediatric LDLT procedures at Sirio-Libanes Hospital/A. C. Camargo Hospital (São Paulo, Brazil) between October 1995 and April 2011. The studied pretransplant variables included the following: recipient age and body weight, Pediatric End-Stage Liver Disease score, z score for height/age, bilirubin, albumin, international normalized ratio, hemoglobin, sodium, presence of ascites, and previous surgery. The analyzed technical aspects included the graft-to-recipient weight ratio and the use of vascular grafts for portal vein reconstruction. In addition, the occurrence of hepatic artery thrombosis (HAT), portal vein thrombosis (PVT), and biliary complications was also analyzed. The liver grafts included 348 left lateral segments, 5 monosegments, 51 left lobes, and 9 right lobes. In a univariate analysis, an age < 12 months, a low body weight (≤10 kg), malnutrition, hyperbilirubinemia, and HAT were associated with decreased patient and graft survival after LDLT. In a multivariate analysis, a body weight ≤ 10 kg and HAT were significantly associated with decreased patient and graft survival. The use of vascular grafts significantly increased the occurrence of PVT. In conclusion, a low body weight (≤10 kg) and the occurrence of HAT independently determined worse patient and graft survival in this large cohort of pediatric LDLT patients.
authors.affiliation: Sirio-Libanes Hospital/A. C. Camargo Hospital, São Paulo, Brazil. joaoseda@gmail.com
authors.forename: Joao Seda
authors.initials: JS
authors.lastname: Neto
authors.forename: Renata
authors.initials: R
authors.lastname: Pugliese
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Fonseca
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Vincenzi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pugliese
authors.forename: Helry
authors.initials: H
authors.lastname: Candido
authors.forename: Alberto B
authors.initials: AB
authors.lastname: Stein
authors.forename: Marcel
authors.initials: M
authors.lastname: Benavides
authors.forename: Bernardo
authors.initials: B
authors.lastname: Ketzer
authors.forename: Hsiang
authors.initials: H
authors.lastname: Teng
authors.forename: Gilda
authors.initials: G
authors.lastname: Porta
authors.forename: Irene K
authors.initials: IK
authors.lastname: Miura
authors.forename: Vera
authors.initials: V
authors.lastname: Baggio
authors.forename: Teresa
authors.initials: T
authors.lastname: Guimaraes
authors.forename: Adriana
authors.initials: A
authors.lastname: Porta
authors.forename: Celso Arrais
authors.initials: CA
authors.lastname: Rodrigues
authors.forename: Francisco C
authors.initials: FC
authors.lastname: Carnevale
authors.forename: Eduardo
authors.initials: E
authors.lastname: Carone
authors.forename: Mario
authors.initials: M
authors.lastname: Kondo
authors.forename: Paulo
authors.initials: P
authors.lastname: Chapchap
mesh_terms: D000293:Adolescent; D000328:Adult; D001835:Body Weight; D005260:Female; D006085:Graft Survival; D006499:Hepatic Artery; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011169:Portal Vein; D013927:Thrombosis / Q000401:mortality; D020246:Venous Thrombosis / Q000401:mortality