TY - JOUR
T1 - Pediatric recipients of three or more hepatic allografts
T2 - Results and technical challenges (1999)
AU - Schindel, David T.
AU - Dunn, Stephen P.
AU - Casas, Adela T.
AU - Falkenstein, Kathleen
AU - Billmire, Deborah F.
AU - Vinocur, Charles D.
AU - Weintraub, William H.
PY - 2000/2
Y1 - 2000/2
N2 - 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.
AB - 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.
KW - Chronic allograft rejection
KW - Liver transplantation
KW - Pediatric liver transplantation
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U2 - 10.1016/S0022-3468(00)90028-9
DO - 10.1016/S0022-3468(00)90028-9
M3 - Article
C2 - 10693684
AN - SCOPUS:0033976368
SN - 0022-3468
VL - 35
SP - 297
EP - 302
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
IS - 2
ER -