Living-related liver transplantation in children

The 'Parisian' strategy to safely increase organ availability

Y. Révillon, J. L. Michel, F. Lacaille, F. Sauvat, O. Farges, J. Belghiti, A. Rengeval, P. Jouvet, N. Sayegh, S. Sarnacki, Dominique M. Jan

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Purpose: The aim of the authors was to report their experience with living related liver transplantation (LRLT) in children, particularly focusing on the safety of the two-center 'Parisian' strategy. Methods: The records of donors and recipients of 26 pediatric living-related donor liver transplantations performed between November 1994 and March 1998 were reviewed retrospectively. Donors were assessed 1 year after transplantation for medical and overall status. Results: Indications for LRLT included biliary atresia (n = 18), Byler's disease (n = 5), alpha-1-antitrypsin deficiency (n = 1), Alagille syndrome (n = 1), and undefined cirrhosis (n = 1). Liver harvesting consisted of either a complete left hepatectomy (n = 14) or left lateral hepatectomy (n = 12) without vascular clamping. The recipient procedure essentially was the same as in split liver transplantation. Mean overall cold ischemia time averaged 140 minutes (range, 90 to 230 minutes). Twenty-four of 26 patients had end-to-end vascular anastomoses without interposition. Biliary reconstruction consisted of a Roux-en-Y choledochojejunostomy in all patients. All recipients except one received cyclosporine A (CSA). Mean donor hospitalization was 8 days (range, 6 to 13) with normalization of all liver function assays by the time of discharge. There were no donor deaths and two postoperative complications (perihepatic fluid collection and bleeding from the wound). One year after donation, the initial 19 donors had resumed their pretransplant status. Two of the children who underwent transplant died. Thirteen of the recipients required reoperation for hepatic artery thrombosis (n = 2), portal vein thrombosis (n = 2), biliary complications (n = 6), fluid collection (n = 3), small bowel perforation (n = 1), and plication for diaphragmatic eventration (n = 1). With mean follow-up of 2 years, 24 of 26 patients are alive and well (patient and g raft survival rate, 92%). Conclusions: LRLT is still controversial, even with minimal and decreasing donor risk. The 'Parisian' strategy consists of harvesting the liver in an adult unit by an adult hepatic surgery team. The transplantation is then performed in a pediatric hospital by the pediatric liver transplantation team. The two steps of the procedure allow units specialized in adult surgery, on one hand, and pediatric liver transplantation, on the other hand, to dedicate themselves completely to their respective procedures, improving the safety of the harvest, and alleviating stress for both the medical staff and the families.

Original languageEnglish (US)
Pages (from-to)851-853
Number of pages3
JournalJournal of Pediatric Surgery
Volume34
Issue number5
DOIs
StatePublished - May 1999
Externally publishedYes

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Liver Transplantation
Tissue Donors
Liver
Hepatectomy
Pediatrics
Blood Vessels
Thrombosis
Diaphragmatic Eventration
Transplantation
Alagille Syndrome
Choledochostomy
alpha 1-Antitrypsin Deficiency
Safety
Cold Ischemia
Biliary Atresia
Pediatric Hospitals
Living Donors
Hepatic Artery
Medical Staff
Portal Vein

Keywords

  • Liver transplantation
  • Living donor

ASJC Scopus subject areas

  • Surgery

Cite this

Living-related liver transplantation in children : The 'Parisian' strategy to safely increase organ availability. / Révillon, Y.; Michel, J. L.; Lacaille, F.; Sauvat, F.; Farges, O.; Belghiti, J.; Rengeval, A.; Jouvet, P.; Sayegh, N.; Sarnacki, S.; Jan, Dominique M.

In: Journal of Pediatric Surgery, Vol. 34, No. 5, 05.1999, p. 851-853.

Research output: Contribution to journalArticle

Révillon, Y, Michel, JL, Lacaille, F, Sauvat, F, Farges, O, Belghiti, J, Rengeval, A, Jouvet, P, Sayegh, N, Sarnacki, S & Jan, DM 1999, 'Living-related liver transplantation in children: The 'Parisian' strategy to safely increase organ availability', Journal of Pediatric Surgery, vol. 34, no. 5, pp. 851-853. https://doi.org/10.1016/S0022-3468(99)90386-X
Révillon, Y. ; Michel, J. L. ; Lacaille, F. ; Sauvat, F. ; Farges, O. ; Belghiti, J. ; Rengeval, A. ; Jouvet, P. ; Sayegh, N. ; Sarnacki, S. ; Jan, Dominique M. / Living-related liver transplantation in children : The 'Parisian' strategy to safely increase organ availability. In: Journal of Pediatric Surgery. 1999 ; Vol. 34, No. 5. pp. 851-853.
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T2 - The 'Parisian' strategy to safely increase organ availability

AU - Révillon, Y.

AU - Michel, J. L.

AU - Lacaille, F.

AU - Sauvat, F.

AU - Farges, O.

AU - Belghiti, J.

AU - Rengeval, A.

AU - Jouvet, P.

AU - Sayegh, N.

AU - Sarnacki, S.

AU - Jan, Dominique M.

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N2 - Purpose: The aim of the authors was to report their experience with living related liver transplantation (LRLT) in children, particularly focusing on the safety of the two-center 'Parisian' strategy. Methods: The records of donors and recipients of 26 pediatric living-related donor liver transplantations performed between November 1994 and March 1998 were reviewed retrospectively. Donors were assessed 1 year after transplantation for medical and overall status. Results: Indications for LRLT included biliary atresia (n = 18), Byler's disease (n = 5), alpha-1-antitrypsin deficiency (n = 1), Alagille syndrome (n = 1), and undefined cirrhosis (n = 1). Liver harvesting consisted of either a complete left hepatectomy (n = 14) or left lateral hepatectomy (n = 12) without vascular clamping. The recipient procedure essentially was the same as in split liver transplantation. Mean overall cold ischemia time averaged 140 minutes (range, 90 to 230 minutes). Twenty-four of 26 patients had end-to-end vascular anastomoses without interposition. Biliary reconstruction consisted of a Roux-en-Y choledochojejunostomy in all patients. All recipients except one received cyclosporine A (CSA). Mean donor hospitalization was 8 days (range, 6 to 13) with normalization of all liver function assays by the time of discharge. There were no donor deaths and two postoperative complications (perihepatic fluid collection and bleeding from the wound). One year after donation, the initial 19 donors had resumed their pretransplant status. Two of the children who underwent transplant died. Thirteen of the recipients required reoperation for hepatic artery thrombosis (n = 2), portal vein thrombosis (n = 2), biliary complications (n = 6), fluid collection (n = 3), small bowel perforation (n = 1), and plication for diaphragmatic eventration (n = 1). With mean follow-up of 2 years, 24 of 26 patients are alive and well (patient and g raft survival rate, 92%). Conclusions: LRLT is still controversial, even with minimal and decreasing donor risk. The 'Parisian' strategy consists of harvesting the liver in an adult unit by an adult hepatic surgery team. The transplantation is then performed in a pediatric hospital by the pediatric liver transplantation team. The two steps of the procedure allow units specialized in adult surgery, on one hand, and pediatric liver transplantation, on the other hand, to dedicate themselves completely to their respective procedures, improving the safety of the harvest, and alleviating stress for both the medical staff and the families.

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