The impact of low recipient weight [≤ 7kg] on long-term outcomes in 1078 pediatric living donor liver transplantations

• Published in: Journal of pediatric surgery Vol. 57; no. 12; pp. 955 - 961
• Main Authors: Neto, João Seda, Chapchap, Paulo, Feier, Flavia H., Pugliese, Renata, Vincenzi, Rodrigo, Benavides, Marcel R, Roda, Karina, Kondo, Mário, Fonseca, Eduardo A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2022
• Subjects: Children; Hepatic artery thrombosis; LEVEL III; Level of evidence; Liver transplantation; Living donation; Outcomes; LL; WIT; Hepatic artery thrombosis; MRI; PV; LT; PELD; EPVT; BL; HVOO; INR; Outcomes; Living donation; HV; BS; LLS; IJV; BW; DDLT; PLDLT; Children; LL+C; LPVT; Level of evidence; LDLT; POD; GRWR; MT; CIT; VG; IMV; NA; MELD; HA; HAT; LGV; RL; LEVEL III; PRBCT; TIT; Liver transplantation; BA; HG
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2022.05.014

•What is currently known about this topic?  Pediatric living donor liver transplantation (PLDLT) in infants and small children is a challenging procedure and requires particular technical refinements. Early vascular complications are still the main cause of patient and graft loss, especially in low body weight recipients, and centers responsible for the care of such patients utilize different strategies to mitigate the problem and achieve better outcomes. .•What new information is contained in this article? This paper analyzes the PLDLT outcomes in children with low body weight (<7 kg). It represents the largest population of PLDLT reported so far. With proper management and different technical strategies to avoid “large-for-size syndrome”, that can increase the occurrence of early vascular complications, the long-term survival of small babies was similar to the group of patients with higher body weight. This series shows that, even challenging, PLDLT in small babies is feasible, with good outcomes. infants who require liver transplantation represent a treatment challenge because chronic liver disease at this early age affects the child's growth and development during a critical phase. The aim is to compare demographics, operative data, and long-term outcomes according to recipient weight at the time of LDLT. This retrospective study included primary LDLT analyzed in 2 groups: BW ≤ 7 kg (n = 322) and BW > 7 kg (n = 756). A historical comparison between periods was also investigated. BW ≤ 7 kg had significantly lower height/age and weight/age z-scores, with median PELD score of 19. Transfusion rates were higher in the BW ≤ 7 kg group (30.9 ml/kg versus 15.5 ml/kg, P < 0.001). Higher frequencies of PV complications were seen in the BW ≤ 7 kg cohort. HAT and retransplantation rates were similar. Those with BW ≤ 7 kg required longer ICU and hospital stays. Patient and graft survival were similar. Patient survival in BW≤ 7 kg was significantly better in the most recent period. Malnutrition and advanced liver disease were more frequent in BW ≤ 7 kg. Despite increased rates of PVT and longer hospital stay, patient and graft long-term survival were similar between groups.