Liver transplantation in infants with biliary atresia: comparison of primary versus temporary abdominal closure.
BACKGROUND
Biliary atresia (BA) is the most frequent disease leading to liver transplantation (LT) in infants. Since the patients often require transplantation before reaching a body weight of 10 kg, it is necessary to perform living-related or split liver transplantation by using a left lateral segment. However, this graft often exceeds a graft body weight ratio (GBWR) of 4. Because of the size mismatch and poor portal venous blood flow in most recipients, temporary abdominal closure is often favoured. The aim of the present study is to investigate the feasibility of primary abdominal closure in this group of extremely small infants undergoing LT.


METHODS
All patients with the diagnosis of BA and a body weight ≤10 kg who underwent LT in our centre between January 2004 and December 2014 were included in this study. Patients who received primary abdominal closure at transplantation (group 1) were compared with those receiving temporary abdominal closure (group 2). The postoperative clinical and biochemical course was analysed. The outcome was determined and correlated with body and graft weight and the GBWR.


RESULTS
Sixty-six LTs were performed in 57 patients in the study period (22 male, 35 female). Thirty-six patients received primary closure (group 1). Twenty-eight patients received temporary closure (group 2). Mean age at LT was 10 months (range 3-26) and mean GBWR 4.8 (range 2.9-9.3). A GBWR ≥4 occurred in 61.1 % in group 1 and in 60.9 % in group 2. There was no significant difference between both groups concerning body weight, graft weight or GBWR. Vascular thrombosis occurred in 8 patients (22 %) and 15 patients (42 %) in group 1 and in 10 patients (36 %) and 11 patients (39 %) in group 2, respectively. Six patients (17 %) of group 1 and five patients (18 %) of group 2 developed an intraabdominal infection postoperatively. After a mean follow-up of 4.6 years (range 1 month-11.1 years), patient and graft survival were 90.1 and 75 % in group 1 and 78.3 and 64.3 % in group 2, respectively.


CONCLUSIONS
In our study, primary abdominal closure displays a similar outcome in comparison to temporary abdominal closure.
Department of General Visceral and Transplant Surgery, Division of Pediatric Surgery, Faculty of Medicine, University Duisburg-Essen, Hufelandstr. 55D, , 45147, Essen, Germany. schukfeh.nagoud@mh-hannover.de.
Nagoud
N
Schukfeh
Department of General Visceral and Transplant Surgery, Division of Pediatric Surgery, Faculty of Medicine, University Duisburg-Essen, Hufelandstr. 55D, , 45147, Essen, Germany.
Anna-Charlotte
AC
Holland
Department of General Visceral and Transplant Surgery, Division of Pediatric Surgery, Faculty of Medicine, University Duisburg-Essen, Hufelandstr. 55D, , 45147, Essen, Germany.
Dieter P
DP
Hoyer
Department of General Visceral and Transplant Surgery, Division of Pediatric Surgery, Faculty of Medicine, University Duisburg-Essen, Hufelandstr. 55D, , 45147, Essen, Germany.
Anja
A
Gallinat
Department of General Visceral and Transplant Surgery, Division of Pediatric Surgery, Faculty of Medicine, University Duisburg-Essen, Hufelandstr. 55D, , 45147, Essen, Germany.
Andreas
A
Paul
Department of General Visceral and Transplant Surgery, Division of Pediatric Surgery, Faculty of Medicine, University Duisburg-Essen, Hufelandstr. 55D, , 45147, Essen, Germany.
Maren
M
Schulze
D058107:Abdominal Wound Closure Techniques; D001656:Biliary Atresia / Q000601:surgery*; D001835:Body Weight; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D016031:Liver Transplantation; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
Biliary complications; Graft body weight ratio; Large for size; Left lateral graft; Living donor; Paediatric surgery