LIVER-TRANSPLANTATION IN CHILDREN - THE EXPERIENCE OF QUEEN-MARY-HOSPITAL, HONG-KONG

Seven living-related liver transplants (LRLT) and two reduced-size liv er transplants (RSLT) were performed on eight children who suffered fr om end-stage liver disease, having previously undergone one to three a bdominal operations. Their ages at initial transplantation ranged from 8 months to 11 years (mean 35 months, median 12 months). Excluding th e two older children aged 7 and 11 years, respectively, the rest of th e children weighed 6 to 9.5 kg (mean 7.3 kg) at the time of the initia l transplantation. Seven left lateral segments (S2 + 3) and two left l obes (S2 + 3 + 4) were used; of these the smallest graft had a graft-t o-recipient body weight ratio of 0.9%. The volunteer living donors wer e four mothers, two fathers and one sister who were selected after med ical and psychiatric evaluations, and their suitability was confirmed by hematological, biochemical, and radiological criteria. During a fol low-up period of 3 to 30 months, all eight children are alive and well with normal liver function, one of them having undergone a retranspla nt LRLT because of hepatitis of undetermined etiology following a RSLT 1.5 years earlier. All seven donors had an uneventful postoperative c ourse and were discharged on day 4 to 7 postoperatively. They have all resumed normal day-to-day activities. There were no complications in the donor group. A variety of complications occurred in the recipients , all of which were overcome. Operating microscope was used to perform all the arterial anastomoses using microvascular techniques. This met hod has proven to be a major factor in preventing arterial thrombosis even with the smallest of arterial anastomosis where a 1.5-mm diameter recipient artery was anastomosed to a 2.5-mm diameter donor hepatic a rtery. Copyright (C) 1997 by W.B. Saunders Company