Living related liver transplantation in infants and children: Report of anesthetic care and early postoperative morbidity and mortality

Study Objective: To determine those infants at high risk for perioperative complications and mortality following living, related liver transplantation . Design: Retrospective chart review. Setting: Large metropolitan teaching hospital. Measurements and Main Results: The charts and anesthetic records of the 12 infants and children who recieved the left lateral hepatic segment from a l iving relative the past 2 years at our institution were reviewed. The recor ds were examined to determine the causes of perioperative morbidity and to identify patients at high risk for serious complications and mortality. All infants and children (mean +/- SD age, 29 +/- 30 months; weight, 13.6 +/- (6.8 kg) survived the operation (8.3 +/- 1.7 hours) without intraoperative complications. The average blood loss, including 500 mL of recipient blood used to flash the liver before, reperfusion, was 1483 +/- 873 mL (119 +/- 7 0 mL/kg). Three infants developed portal vein thrombosis, and one of these infants also had hepatic artery thrombosis. The risk of vessel thrombosis w as significantly higher (3/3 vs. 0/9; p < 0.045) in infants less than 9 kg body weight, as was the risk of death (2/3 vs. 0/9; p < 0.045). Both childr en who died had vascular thrombosis. Other serious complications were bleed ing; 6; infection, 7; acute rejection, 3; and bile leak, 2. Conclusions: Infants and children can successfully undergo living related l iver transplantation. However, the risks of vascular complications and deat h are greater in infants less than 9 kg body weight. (C) 2000 by Elsevier S cience Inc.