title: Living Donor Liver Transplantation in Children: Surgical and Immunological Results in 250 Recipients at Université Catholique de Louvain.
abstract: OBJECTIVE
  To evaluate the outcome of pediatric living donor liver transplantation (LDLT) regarding portal vein (PV) reconstruction, ABO compatibility, and impact of maternal donation on graft acceptance.
  
  
  BACKGROUND
  LDLT and ABO-mismatched transplantation constitute feasible options to alleviate organ shortage in children. Vascular complications of portal hypoplasia in biliary atresia (BA) and acute rejection (AR) are still major concerns in this field.
  
  
  METHODS
  Data from 250 pediatric LDLT recipients, performed at Cliniques Universitaires Saint-Luc between July 1993 and June 2012, were collected retrospectively. Results were analyzed according to ABO matching and PV complications. Uni- and multivariate analyses were performed to study the impact of immunosuppression, sex matching, and maternal donation on AR rate.
  
  
  RESULTS
  Overall, the 10-year patient survival rate was 93.2%. Neither patient or graft loss nor vascular rejection, nor hemolysis, was encountered in the ABO nonidentical patients (n = 58), provided pretransplant levels of relevant isoagglutinins were below 1/16. In BA recipients, the rate of PV complications was lower after portoplasty (4.6%) than after truncal PV anastomosis (9.8%) and to jump graft interposition (26.9%; P = 0.027). In parental donation, maternal grafts were associated with higher 1-year AR-free survival (55.2%) than paternal grafts (39.8%; P = 0.041), but only in BA patients.
  
  
  CONCLUSIONS
  LDLT, including ABO-mismatched transplantation, constitutes a safe and efficient therapy for liver failure in children. In BA patients with PV hypoplasia, portoplasty seems to constitute the best technique for PV reconstruction. Maternal donation might be a protective factor for AR.
authors.affiliation: *Pediatric Liver and Liver Transplantation Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium †Internal Medicine Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium ‡Anesthesiology Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium §Pediatric Radiology Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium ¶Adult Radiology Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium ||Pediatric Intensive Care Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium **Clinical Transplant Immunology Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium ††Pathology Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium ‡‡Abdominal Liver Transplant Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium §§Adult Intensive Care Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Michael
authors.initials: M
authors.lastname: Gurevich
authors.forename: Vanessa
authors.initials: V
authors.lastname: Guy-Viterbo
authors.forename: Magdalena
authors.initials: M
authors.lastname: Janssen
authors.forename: Xavier
authors.initials: X
authors.lastname: Stephenne
authors.forename: Françoise
authors.initials: F
authors.lastname: Smets
authors.forename: Etienne
authors.initials: E
authors.lastname: Sokal
authors.forename: Chantal
authors.initials: C
authors.lastname: Lefebvre
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Balligand
authors.forename: Thierry
authors.initials: T
authors.lastname: Pirotte
authors.forename: Francis
authors.initials: F
authors.lastname: Veyckemans
authors.forename: Philippe
authors.initials: P
authors.lastname: Clapuyt
authors.forename: Renaud
authors.initials: R
authors.lastname: Menten
authors.forename: Dana
authors.initials: D
authors.lastname: Dumitriu
authors.forename: Etienne
authors.initials: E
authors.lastname: Danse
authors.forename: Laurence
authors.initials: L
authors.lastname: Annet
authors.forename: Stephan Clement de
authors.initials: SC
authors.lastname: Clety
authors.forename: Thierry
authors.initials: T
authors.lastname: Detaille
authors.forename: Dominique
authors.initials: D
authors.lastname: Latinne
authors.forename: Christine
authors.initials: C
authors.lastname: Sempoux
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Laterre
authors.forename: Catherine
authors.initials: C
authors.lastname: de Magnée
authors.forename: Jan
authors.initials: J
authors.lastname: Lerut
authors.forename: Raymond
authors.initials: R
authors.lastname: Reding
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D000293:Adolescent; D000328:Adult; D001787:Blood Group Incompatibility; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011169:Portal Vein / Q000601:surgery; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System