title: Clinical evaluation of hepatic transection on pediatric liver transplantation.
abstract: OBJECTIVE
  Liver transplantation is an effective technique in the treatment of end-stage liver disease. The aim of this study was to evaluate the impact of hepatic transection, an advanced surgical technique able to tailor size to generate two grafts to from a single donor.
  
  
  METHODS
  A retrospective study between January 2000 and September 2013, reviewing 91 pediatric patients who underwent 96 liver transplants from deceased donors. Patients were distributed into two groups: whole organ (WO, n = 39) and transected liver grafts (TLG, n = 57). The following were evaluated: etiology, anthrophometric parameters (age, weight, height, z score weight/age, and height/age), model for end-stage liver disease (MELD) or pediatric end-stage liver disease (PELD), previous surgeries, transfusion of blood components, 1-year survival rate, preoperative laboratory testing, from the second and seventh postoperative days, lactate during surgery, postoperative complications, duration of surgery, duration of cold and warm ischemia, types of biliary reconstruction, and laboratory testing of the donor.
  
  
  RESULTS
  The anthropometric values showed significant differences (P < .05) between the groups. The average age was 124.7 months in the WO group and 33.6 months in the TLG group (P < .0001), while the weight was 28.0 kg and 7.4 kg, respectively (P < .0001). The analysis of z score weight/age showed that the TLG had greater acute and chronic malnutrition, probably due to the etiology of liver disease, present from birth in patients as young. Red blood transfusion was higher in the TLG group (P < .0006) due to the cut surface of the graft, emphasizing the use and improvement of hemostatic techniques.
  
  
  CONCLUSIONS
  Despite differences between the groups, clinical and surgical complications were similar, showing that liver transection injury didn't change the results of transplantation. There was no impact on liver function, graft, or 1-year patient survival after liver transection. Second postoperative lactate is a predictive factor of death. Transection liver transplantation is an effective method as an alternative to pediatric liver transplantation.
authors.affiliation: Hospital São Paulo, Universidade Federal de São Paulo - UNIFESP, Surgery Department - Course of Gastroenterological Surgery, Sao Paulo, Brazil. Electronic address: barbarabenini@gmail.com.
authors.forename: B B
authors.initials: BB
authors.lastname: Benini
authors.affiliation: Hospital São Paulo, Universidade Federal de São Paulo - UNIFESP, Surgery Department - Course of Gastroenterological Surgery, Sao Paulo, Brazil.
authors.forename: A A
authors.initials: AA
authors.lastname: Salzedas-Netto
authors.affiliation: Hospital São Paulo, Universidade Federal de São Paulo - UNIFESP, Surgery Department - Course of Gastroenterological Surgery, Sao Paulo, Brazil.
authors.forename: R A
authors.initials: RA
authors.lastname: de Azevedo
authors.affiliation: Hospital São Paulo, Universidade Federal de São Paulo - UNIFESP, Surgery Department - Course of Gastroenterological Surgery, Sao Paulo, Brazil.
authors.forename: J L
authors.initials: JL
authors.lastname: Martins
authors.affiliation: Hospital São Paulo, Universidade Federal de São Paulo - UNIFESP, Surgery Department - Course of Gastroenterological Surgery, Sao Paulo, Brazil.
authors.forename: M M
authors.initials: MM
authors.lastname: Linhares
authors.affiliation: Hospital São Paulo, Universidade Federal de São Paulo - UNIFESP, Surgery Department - Course of Gastroenterological Surgery, Sao Paulo, Brazil.
authors.forename: F P P
authors.initials: FP
authors.lastname: Vicentine
authors.affiliation: Hospital São Paulo, Universidade Federal de São Paulo - UNIFESP, Surgery Department - Course of Gastroenterological Surgery, Sao Paulo, Brazil.
authors.forename: A M
authors.initials: AM
authors.lastname: Gonzalez
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D058625:End Stage Liver Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome