Jd. Degoyet et al., IMPACT OF INNOVATIVE TECHNIQUES ON THE WAITING LIST AND RESULTS IN PEDIATRIC LIVER-TRANSPLANTATION, Transplantation, 56(5), 1993, pp. 1130-1136
The wide application of liver transplantation in children is hampered
by the shortage of size-matched pediatric donors; this results in high
mortality rate on the waiting list, a long waiting time, worsening of
the clinical condition of the waiting patient, deterioration of the o
verall results, and an increase in the cost. Reduced-size liver transp
lants have been shown to be a safe way to alleviate the shortage of si
ze-matched organs. We have retrospectively analyzed the impact of the
reduced-size liver transplants on the waiting list and the results in
a consecutive series of 314 transplants performed in 261 children over
an 8-year period (1984-1991). Among these 314 grafts, 160 (51%) were
innovative techniques including 86 reduced livers (stricto senso), 66
partial livers (with preservation of the recipient vena cava), and 8 s
plit livers. Such an extensive use of these technical variants allowed
a sharp decrease in the waiting list mortality: from 14.9% between 19
84 and 1989 to 6.6% in 1990 and 5% in 1991; the corresponding figures
for infants registered under the age of 1 year were 25%, 13.3%, and 8.
3%, respectively. Results obtained with a full-size graft or a technic
al variant were similar regarding surgical complications (with a signi
ficantly lower incidence of arterial thrombosis for the reduced transp
lants), graft loss, and patient survival. The 5-year survival of the w
hole group was 78.1% without any significant difference regarding type
of transplant, indications (with the best results: 89.4% 5-year survi
val obtained in 41 children grafted for metabolic diseases), or age (t
he 5-year survival was 82.2% for the 41 infants transplanted under the
age of 1 year, 78.9% for the 124 children transplanted between 1 and
3 years, and 81.3% for the 96 children transplanted between 6 and 15 y
ears). This series of reduced-size liver transplants, which is the lar
gest worldwide single institutional experience, confirms that the exte
nsive use of reduced transplants in children is safe; this study also
shows that innovative techniques, including the split liver, allow a d
rastic decrease of the waiting list mortality of candidates in the ped
iatric age range without alterations of the results.