Liver transplantation with a living related donor in children

Objectifs - Liver transplantation with living related donor has been recent ly developed to compensate for the insufficient number of liver grafts for children. The major problem is ethical because it implies voluntary mutilat ion of a healthy person This paper report results in 37 living related dono rs. Patients - Recipients were followed in Enfants-Malades Hospital. Investigat ions and donor surgery were performed at the Digestive Surgery Unit of Beau jon Hospital. Results - One donor was re-operated for bleeding, and another one a biliary fistula treated with percutaneous drainage for one week. The post-operativ e course was uneventful in the other donors, with a follow-up of between 2 and 50 months. Thirty-three children are alive (90%), one of them underwent a second transplant for arterial thrombosis. Vascular and infectious compl ications, and the number of rejection episodes were the same as in transpla ntations with a deceased donor. Biliary complications were frequent (15 pat ients out of 37) and significantly increased morbidity. A teenage boy who r eceived a small graft (0.9% of his weight) presented initially with hepatic insufficiency without encephalopathy. Conclusion - This technique has been shown to have a good balance between b enefits and risks. Our experience confirms this, especially in very young c hildren. Each case should be discussed individually and parental consent sh ould be obtained without external pressure. Experience with this technique should be continued and at the same time the use of cadaveric grafts should be optimized.