LIVER TRANSPLANTATION IN CHILDREN: 14 YEARS OF EXPERIENCE WITH LIVING DONORS

Abstract

OBJECTIVES: Report on the experience with 170 living donors in pediatric liver transplantation. MATERIAL AND METHODS: Retrospective analysis of the medical records of donors operated between June 1998 and October 2012. RESULTS: Over the past 14 yrs, 169 liver transplants were performed in pediatric recipients of living donor grafts. In a potential left lateral segment donor, there was a minor injury in the right branch of portal vein, repaired without consequences for the patient, but resulting in abortion of the transplant. From the remaining donors, 151 left lateral segments (89.34%), 17 left lobes (10.06%) and 1 right lobe (0.6%) were removed. Donor age ranged from 16 to 53 yrs and weight ranged from 47 to 106 kg. Transfusion of blood products was required in 14 donors (8.3%). The mean hospital stay was 5 days. Complications were identified in 21 patients (12.4%): 11 showed intense dyspeptic symptoms and abdominal pain (two patients underwent reoperation), seven presented minor bile leaks, and three developed extra-peritoneal infection (incision abscess, phlebitis and pneumonia). There was no mortality in this series. Eight grafts (4.7%) had primary dysfunction, resulting in death of the recipient (three cases of fulminant hepatitis, one metabolic disease carrier, one Alagille Syndrome carrier and three cases of biliary atresia in infants under 1 yr of age). CONCLUSION: Living-related liver transplantation in children generates low risk and morbidity for the donors of left lobe or left lateral segment grafts, with good outcomes for the recipients, eliminating the disadvantages of the waiting list for cadaveric grafts.