Pediatric recipients of three or more hepatic allografts: Results and technical challenges (1999)

David T. Schindel, Stephen P. Dunn, Adela T. Casas, Kathleen Falkenstein, Deborah F. Billmire, Charles D. Vinocur, William H. Weintraub

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Background/Purpose: Children who require a liver transplant at an early age risk chronic allograft rejection (CAR) and other causes of allograft loss. Multiple retransplants may be required for long-term patient survival. The authors evaluate this approach based on our results and technical difficulties. Methods: Charts of 7 children who received 3 or more liver transplants from 1989 to the present were reviewed retrospectively. Results: A total of 151 children required liver transplantation at our institution since 1989. Of these, 4 boys and 3 girls (mean age, 6.2 years; range, 3 to 14 years) have received 3 or more allografts. The etiology of liver failure for the penultimate allograft was CAR (n = 6) and hepatic artery thrombosis (HAT; n = 1). Five cases required modification of portal vein or hepatic artery anastomoses. Two patients with vena caval strictures required supradiaphragmatic vena caval reconstruction. The original Roux-en-Y limb was adequate for biliary reconstruction in all cases. Five children currently are alive (survival rate, 71%) with good graft function having had a mean follow- up of 23 months (range, 2 to 48 mos.). Conclusions: The operative procedure for the multiple hepatic transplant child is challenging. The transplant team must be prepared for intraoperative issues such as extended organ ischemia time during hepatectomy, extensive blood loss, and potential need for creative organ revascularization techniques. Overall, multiple retransplant results are good and justify the use of multiple allografts. Copyright (C) 2000 by W.B. Saunders Company.

Original languageEnglish (US)
Pages (from-to)297-302
Number of pages6
JournalJournal of Pediatric Surgery
Volume35
Issue number2
Publication statusPublished - Feb 2000

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Keywords

  • Chronic allograft rejection
  • Liver transplantation
  • Pediatric liver transplantation

ASJC Scopus subject areas

  • Surgery

Cite this

Schindel, D. T., Dunn, S. P., Casas, A. T., Falkenstein, K., Billmire, D. F., Vinocur, C. D., & Weintraub, W. H. (2000). Pediatric recipients of three or more hepatic allografts: Results and technical challenges (1999). Journal of Pediatric Surgery, 35(2), 297-302.