Experience with living related liver transplantation in 63 children.

摘要: The incentive to develop intrafamilial living related liver transplantation (LRLT) originated from the shortage of cadaveric organ supply. We report our experience with LRLT in 63 children during 1993-1998 frame a protocol approved by Ethics Committee Institution. During this period, 152 potential (mostly parental) donors were evaluated; 44 (28.5%) excluded because surgical (n = 4), medical 39) or psychosocial reason 1). Out 108 who matched all medical, and psychological criteria selection, 45 did not underwent donation their child received graft 22; was second option) one parents had both been selected chosen [by team more favourable anatomy 8) mutual agreement between two 5)]. Sixty-three (36 mothers, 24 fathers, grand mother, aunt uncle) procurement left lobe 52), extended part segment IV hepatectomy 3) without mortality any serious morbidity. Their median hospital stay 7 days (range: 6-12); full physical rehabilitation normalization tests usually obtained within three weeks. follow-up disclose longstanding sequellae. age recipients 13 months (range 5-189); 30 younger than year at time transplant. weight 8.1 kg 4.3 60); 36 an actual under 10 kg. Fifty-two ABO identical 11 compatible native diseases similar common data children, biliary atresia being most frequent indication (74.6%). 260 gr 138-680) ratio recipient body 3.17% 0.75-8.08). All grafts implanted orthotopically semi-microvascular reconstruction hepatic vein, portal vein artery [end end anastomosis 58 (2 arteries reconstructed patients) interposition iliac arterial allograft infrarenal aorta 5]. Base line immunosuppression consisted triple drug regimen including steroids, Azathioprine either Cyclosporine-Sandimmun 9), Cyclosporine Microemulsion formulation-Neoral 13) Tacrolimus-Prograft 41). Biopsy-proved acute rejection treated intravenous bolus steroids; steroid-resistant switch Tacrolimus addition Mycophenolate-Mofetil (Cellcept) patients. Actuarial patient survival 91.8% 89.6% after five years post-transplant, respectively, 87.5% 82.8% years, 90 patients same interval. 84.1% 76.4% 73.3% transplants. Vascular thrombosis observed 9.5% (arterial thrombosis: 1.6%; 7.9%) loss. Biliary complications 26.9% (bile leak cut surface 3.1%, anastomotic stricture 22.2% intrahepatic 1.5%); died septic shock possibly uncompletely relieved stricture; other successfully conservatively surgically. incidence 90.9% 22 Cyclosporine-based immunosuppression; corticoresistant 50%. It 46.3% 41 Tacrolimus-based (64% Prograft capsules 18.7% granules); no corticoresistant. (ABSTRACT TRUNCATED)