Pediatric recipients of three or more hepatic allografts: Results and technical challenges

Background/Purpose: Children who require a river 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 difficul ties. 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 inst itution since 1989. Of these, 4 boys and 3 girls (mean age, 6.2 years; rang e, 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 t hrombosis (HAT; n = 1). Five cases required modification of portal vein or hepatic artery anastomoses. Two patients with vena caval strictu res requir ed supradlaphragmatic venacaval reconstruction. The original Roux-en-Y limb was adequate for biliary reconstruction in ail cases. Five children curren tly are alive (survival rate, 71%) with good graft function having had a me an follow-up of 23 months (range, 2 to 48 mos.). Conclusions: The operative procedure for the multiple hepatic transplant ch ild 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 techniq ues. Overall, multiple retransplant results are good and justify the use of multiple allografts. J Pediatr Surg 35:297-302. Copyright (C) 2000 by W.B. Saunders Company.