Innovative techniques in pediatric liver transplantation : Anatomical basis and clinical experience with orthotopic cadaveric liver graft transplantations
(1995)
Files
247615_DeVilledeGoyet_These.pdf
Restricted Access - Adobe PDF
- 15.99 MB
Details
- Authors
- Supervisors
- Otte, Jean-Bernard
- Abstract
- In children, mortality form liver diseases are mostly concentrated in infancy. In the absence of alternative techniques, the scarcity of small donor organs would have been a major limiting factor in the development of pediatric liver transplantation, with an unacceptably high pre-transplantation mortality rate. Transplantation of cut-down (commonly called ‘reduced-size’) graft was first developed and is now a well accepted procedure; this technique evolved with time from the right hepactectomised liver graft to a more complex hyper-reduced segment II-III graft.<BR> Although discarding the right part is considered by some as a negative aspect of the procedure, retaining all hilar structures of large donor livers lowers the incidence of hepatic artery thrombosis and biliary anastomotic strictures in pediatric liver transplantation; the graft and patient survival rates are similar whether a full-size or a cutdown liver graft is used, in elective conditions. Although lower survival rates were found in urgent patients, we consider after scrutinous analysis that this is not related to the technique. <BR> The experience gained through cutting down the right part opened the way to retaining this latter as a graftits own vascularisation obtained by division of the hilar structures : the split liver graft. Split liver graft transplantation is obviously a greater technical challenge. Initial results were somewhat disappointing. A learning phase probably contributed to a higher rate of complications and graft loss. With increasing experience, better results have been reported; recent series and our analysis of the current European experience have shown that good results and similar survival rates can also be achieved. <BR> The shortage of donor is the primary challenge facing the liver transplant community today and has fuelled some of the major controversies currently being debated. The lack of cadaveric donor organs is likely to persist, and either or both of two avenues, must develop in the future: innovative techniques and/or searching the most ethical allocation of a limited number of liver grafts for a growing number of recipients. Cut-down technique does not increase, per se, the absolute number of hepatic grafts available, but scrapping this technique would provide a limited increase in graft availability for adult recipients (6%). Living-related liver transplantations currently represent less than 5% of the total number of liver transplantations in Eurotransplant. Division of cadaveric liver grafts is undoubtedly the more significantly the liver graft availability
- Affiliations
Citations
de Ville de Goyet, J. (1995). Innovative techniques in pediatric liver transplantation : Anatomical basis and clinical experience with orthotopic cadaveric liver graft transplantations. https://hdl.handle.net/2078.5/111336