Y. Revillon et al., Living-related liver transplantation in children: The 'Parisian' strategy to safely increase organ availability, J PED SURG, 34(5), 1999, pp. 851-853
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 a nd recipients of 26 pediatric living-relate
d donor liver transplantations performed between November 1994 and March 19
98 were reviewed retrospectively. Donors were assessed 1 year after transpl
antation for medical and overall status.
Results: Indications for LRLT included biliary atresia (n = 18), Byler's di
sease (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 average
d 140 minutes (range, 90 to 230 minutes). Twenty-four of 26 patients had en
d-to-end vascular anastomoses without interposition. Biliary reconstruction
consisted of a Roux-en-Y choledochojejunostomy in all patients. All recipi
ents except one received cyclosporine A (CSA). Mean donor hospitalization w
as 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). O
ne year after donation, the initial 19 donors had resumed their pretranspla
nt status. Two of the children who underwent transplant died. Thirteen of t
he recipients required reoperation for hepatic artery th rom basis (n = 2),
portal vein thrombosis (n = 2), biliary complications (n = 6), fluid colle
ction (n = 3), small bowel perforation (n = 1), and plication for diaphragm
atic eventration (n = ?). With mean follow-up of 2 years, 24 of 26 patients
are alive and well (patient and graft 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 pe
rformed 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, an the other hand, to ded
icate themselves completely to their respective procedures, improving the s
afety of the harvest, and alleviating stress for both the medical staff and
the families. Copyright (C) 1999 by W.B. Saunders Company.