Detailed Abstract
[E-poster - Liver (Transplantation)]
[EP 112] Outcomes of 32 Infant Living-Donor Liver Transplantations in a National Paediatric Referral Unit in Singapore
Esther CHAN1, Dale LOH1, Marion AW2, Venkatesh KARTHIK2, James HUANG2, Michelle TAN2, Yoke Lin NYO1, Ahamed ABUBACKER1, Yang Yang LEE1, Vidyadhar MALI1
1Department of Pediatric Surgery, National University Hospital, Singapore, Singapore, 2Department of Gastroenterology, National University Hospital, Singapore
Background : We report patient and graft survival outcomes in paediatric living-donor liver transplantation (LDLT) at or under the age of 1 year in our institution.
Methods : Retrospective review of all infant LDLT (n=32) in a national paediatric referral unit in a single institute. Children within one month of their first birthday were included as infants in this study.
Results : Median age and weight were 300 days (range 130-389 days) and 8 kg (range 5.9 – 10.1kg) respectively. The aetiology was biliary atresia/cholestatic (n=27), metabolic (n=2), drug-induced liver failure (n=1) and miscellaneous (n=2). Median graft-to-recipient-weight ratio (GRWR) at implantation was 3.3 (range 1.77-4.8). Median follow-up was 83 months (range 11-146 months). Patient and graft survivals were 87.5% and 84.3% at 1 year and 84.3% and 81.3% at 5 years respectively. The vascular complications rate (portal vein thrombosis PVT = 6, stenosis PVS =2, hepatic artery thrombosis HAT = 2, hepatic vein thrombosis = 1) was 37.5 %. Biliary complication rate was 12.5% (leak = 1, strictures = 4). Infant LDLT numbers doubled in the last decade (2014-2023; n = 22). Hyper-reduced grafts were introduced from the year 2014 onwards (n = 3, median age-262 days; range 130-269 days, median weight-5.5kg; range 4.2-6.0kg). Median GRWR at implant was 3.7; range 3.3-4.5. Vascular complication rate was 100% (HAT= 1, PVT =1, PVS =1). Patient and graft survival were 66.7% each. Mixed reality imaging (combination of Microsoft hololens and Liver vision software) was utilised in 2 infants in addition to conventional donor computerised tomography scans as a size-matching methodology. Postoperatively, there were no large-for-size issues in the recipients and no major morbidity or mortality in their respective donors.
Conclusions : Favourable outcomes can be achieved for infant LDLT in a mature paediatric programme. Technical advances in reduction hepatectomy make it feasible to perform LDLT on younger infants.
Methods : Retrospective review of all infant LDLT (n=32) in a national paediatric referral unit in a single institute. Children within one month of their first birthday were included as infants in this study.
Results : Median age and weight were 300 days (range 130-389 days) and 8 kg (range 5.9 – 10.1kg) respectively. The aetiology was biliary atresia/cholestatic (n=27), metabolic (n=2), drug-induced liver failure (n=1) and miscellaneous (n=2). Median graft-to-recipient-weight ratio (GRWR) at implantation was 3.3 (range 1.77-4.8). Median follow-up was 83 months (range 11-146 months). Patient and graft survivals were 87.5% and 84.3% at 1 year and 84.3% and 81.3% at 5 years respectively. The vascular complications rate (portal vein thrombosis PVT = 6, stenosis PVS =2, hepatic artery thrombosis HAT = 2, hepatic vein thrombosis = 1) was 37.5 %. Biliary complication rate was 12.5% (leak = 1, strictures = 4). Infant LDLT numbers doubled in the last decade (2014-2023; n = 22). Hyper-reduced grafts were introduced from the year 2014 onwards (n = 3, median age-262 days; range 130-269 days, median weight-5.5kg; range 4.2-6.0kg). Median GRWR at implant was 3.7; range 3.3-4.5. Vascular complication rate was 100% (HAT= 1, PVT =1, PVS =1). Patient and graft survival were 66.7% each. Mixed reality imaging (combination of Microsoft hololens and Liver vision software) was utilised in 2 infants in addition to conventional donor computerised tomography scans as a size-matching methodology. Postoperatively, there were no large-for-size issues in the recipients and no major morbidity or mortality in their respective donors.
Conclusions : Favourable outcomes can be achieved for infant LDLT in a mature paediatric programme. Technical advances in reduction hepatectomy make it feasible to perform LDLT on younger infants.
SESSION
E-poster
E-Session 03/21 ALL DAY