Detailed Abstract
[E-poster - Liver (Transplantation)]
[EP 066] 3D Reconstruction and Heterotopic Implantation of Reduced Size Monosegment or Left Lateral Segment and Left Lobe Grafts to Right Diaphragmatic Fossa in Pediatric LDLT: Mid-term results
Emre ARAY1, Deniz BALCI1, Meltem BINGOL KOLOGLU2, Elvan Onur KIRIMKER3, Aydan KANSU4, Zarife KULOGLU4, Suat FITOZ5, Ozlem CAN6, Tanil KENDIRLI4, Kaan KARAYALCIN3
1Department of Surgery, Bahcesehir University School of Medicine Medicalpark Goztepe Hospital, Turkey 2Department of Pediatric Surgery, Ankara University School of Medicine, Turkey, 3Department of Surgery, Ankara University School of Medicine, Turkey, 4Department of Pediatrics, Ankara University School of Medicine, Turkey, 5Department of Radiology, Ankara University School of Medicine, Turkey, 6Department of Anesthesiology, Ankara University School of Medicine, Turkey
Background : Recently we introduced a new method of reduced size monosegment or LLS grafts transplanted in the right diaphragmatic fossa heterotopically in small infants. we aimed to present mid-term results.
Methods : There were 18 pediatric recipients (14 infants, 4 children) who underwent LDLT with this technique, at two centers. The demographic, operative, postoperative and follow up data of these infants were collected from our prospectively designed database and reviewed.
Results : Mean recipient age was 15.7±13.3months (range:5-156 months) and body weight was 8.4±2.5 kg (range: 4.2kg-31kg). Primary diagnoses of recipients were biliary atresia(n:10), progressive familial intrahepatic cholestasis (PFIC) (n:5),cryptogenic (n:2) and Fulminant liver failure(n:1). Mean GRWR was 2.8±0.27. Reduced and hyper-reduced LLS grafts were used in 12 cases,reduced mono-segment III grafts were used in 2 patients and left lobe grafts were used in 4 older children. Bile duct reconstruction was performed by Roux-Y-hepaticojejunostomy in 14 patients and duct to duct anastomosis in 4 patients. Full abdominal closure was achieved in 83%(n:12) of patients and 17% (n:3 ) patients required staged abdominal closure. In the first two operation bile anastomosis was performed before vascular anastomosis, then it was done as in regular order. With a median follow-up of 30.3 months no vascular complication was seen.There were only one patient requiring relaparatomy who had small intestine perforation at terminal ileum occurred in the early postoperative period. Biliary complications (late anastomotic stricture (n:1), late non-anastomotic stricture (n:1), late non anastomotic bile leak (n:1) were developed in 3 (16% ) patients. Other late complications were ACR (n:3,(16%)) ,PTLD(n:2,(11%)). All patients are alive and recovered from transplantation related complications and are doing well with a mean follow up of 30.3 months.
Conclusions : Our midterm results show that LDLT with heterotopically implanted left sided grafts is a feasible technique with promising and satisfactory results in pediatric patients.
Methods : There were 18 pediatric recipients (14 infants, 4 children) who underwent LDLT with this technique, at two centers. The demographic, operative, postoperative and follow up data of these infants were collected from our prospectively designed database and reviewed.
Results : Mean recipient age was 15.7±13.3months (range:5-156 months) and body weight was 8.4±2.5 kg (range: 4.2kg-31kg). Primary diagnoses of recipients were biliary atresia(n:10), progressive familial intrahepatic cholestasis (PFIC) (n:5),cryptogenic (n:2) and Fulminant liver failure(n:1). Mean GRWR was 2.8±0.27. Reduced and hyper-reduced LLS grafts were used in 12 cases,reduced mono-segment III grafts were used in 2 patients and left lobe grafts were used in 4 older children. Bile duct reconstruction was performed by Roux-Y-hepaticojejunostomy in 14 patients and duct to duct anastomosis in 4 patients. Full abdominal closure was achieved in 83%(n:12) of patients and 17% (n:3 ) patients required staged abdominal closure. In the first two operation bile anastomosis was performed before vascular anastomosis, then it was done as in regular order. With a median follow-up of 30.3 months no vascular complication was seen.There were only one patient requiring relaparatomy who had small intestine perforation at terminal ileum occurred in the early postoperative period. Biliary complications (late anastomotic stricture (n:1), late non-anastomotic stricture (n:1), late non anastomotic bile leak (n:1) were developed in 3 (16% ) patients. Other late complications were ACR (n:3,(16%)) ,PTLD(n:2,(11%)). All patients are alive and recovered from transplantation related complications and are doing well with a mean follow up of 30.3 months.
Conclusions : Our midterm results show that LDLT with heterotopically implanted left sided grafts is a feasible technique with promising and satisfactory results in pediatric patients.
SESSION
E-poster
E-Session 03/21 ALL DAY