2016 - IPTA Fellows Meeting


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Mini Oral Abstract Presentations

18.57 - 350 pediatric living donor liver transplantations at Saint-Luc University Clinics:
evolution of surgical techniques, immunosuppression and overall outcomes along the last 23 years

Presenter: Aurore, Pire, Brussels, Belgium
Authors: Aurore Pire, Catherine de Magnée, Beelke D'hondt, Magda Janssen, Raymond Reding

350 pediatric living donor liver transplantations at Saint-Luc University Clinics: evolution of surgical techniques, immunosuppression and overall outcomes along the last 23 years

Aurore Pire1, Catherine de Magnée1, Beelke D'hondt1, Magda Janssen1, Raymond Reding1.

1Pediatric surgery, Saint-Luc Universitary Clinics, Brussels, Belgium

Introduction: Liver transplantation (LT) has become the gold standard therapy for acute and chronic liver failure in children. Due to the shortage of and/or lack of access to deceased donors, living donor liver transplantation (LDLT) has contributed to allow the transplantation of children in a timely fashion regarding the evolution of their diseases. We reviewed our 23 years experience in LDLT in order to document progresses regarding surgical techniques, immunosupression and overall outcomes during this interval.

Patients and Methods: Between July 1993 and December 2015, 636 pediatric LT were performed at our institution, including 350 LDLT (55%). The data of these 350 living donors and transplant recipients (median age: 1.25y; range: 0.3-16.5y) were retrospectively collected and thoroughly reviewed, the main results being presented in this abstract. The indications for LT were: biliary atresia (n=218, 62%), hepatic malignancies (n=42, 12%), familial cholestases (n=39, 11%), metabolic diseases (n=23, 7%), and others (n=28, 8%). Surgical techniques in donors and recipients at our center were described elsewhere, including the use of the ductus venosus hanging maneuver in donors since 2010, and of portoplasty in case of portal hypoplasia in the recipients since 2004 (1). From 2001 onwards, steroid-free immunoprophylaxis was implemented in all children. Moreover, ABO-incompatible LT was performed in 21 children (6%) since 2001, using a particular protocol for isoagglutinin depletion including anti-B monoclonal antibodies and plasma exchanges.

Results: No mortality or persisting disability was encountered in the 350 living donors of this series. Overall patient and graft survivals in the recipients were 96% and 95% at one year, and 94% and 92% at five years, respectively. The retransplantation rate was 8/350 (2.3%), including two children who finally died. No ABO-incompatible graft was lost in this series. To better evaluate our learning curve, the results were further analyzed considering five eras. A striking feature was the progressive increase of the proportion of LDLT/total pediatric LT along the eras as follows: 1993-7: 57/152 (38%); 1998-2001: 38/100 (38%); 2002-7: 66/161 (41%); 2008-11: 80/101 (79%); 2012-15: 108/122 (88%). When comparing 1993-7 and 2007-11 eras, 5 year patient and graft survival rates increased from 89% to 98%, and 86% to 96%, respectively.

Conclusions: Our results indicate: (1) the increasing recourse to LDLT at our pediatric LT program; (2) the safety of living donor surgery and management; (3) the improvement of overall results of LDLT along the eras; (4) the judicious use of ABO-incompatible LDLT due to an adequate protocol for isoagglutinin depletion. A detailed assessment of the risks/benefits balance of steroid-free immunosuppression in pediatric LT is ongoing.

References:

[1] Gurevich M. Living Donor Liver Transplantation in Children: Surgical and Immunological Results in 250 Recipients at Université Catholique de Louvain. Annals of Surgery. 2015; 262: 1141-1149.


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