The impact of liver reductions in pediatric liver transplantation
C. O. Esquivel, P. Nakazato, K. Cox, W. Concepcion, W. Berquist and T. R. Russell
Pacific Transplant Institute, California Pacific Medical Center, San Francisco 94115.
Reduced-size liver transplantation (RSLT) in children was introduced to
alleviate a shortage of small-organ donors. The impact of RSLT on the
waiting time for an organ and on morbidity and mortality was investigated.
Between March 25, 1988, and August 11, 1990, 61 hepatic transplantations
were performed in 55 children at the Pacific Transplant Institute in San
Francisco, Calif. Full-size liver transplantation was performed in 41 cases
and RSLT in 20 cases. The overall 30-month actuarial patient and graft
survival rates were 89% and 73%, respectively. A comparison between
full-size liver transplantation and RSLT showed no difference in patient
and graft survival, reoperations, infections, or rejection. Benefits of
RSLT were an increase in the donor pool size, a decrease in waiting time
for a suitable donor, and a decrease in the rate of arterial thrombosis.
The main morbidity of RSLT was an increase in perioperative blood
requirement. We conclude that RSLT offers small children with end-stage
liver disease a chance for long-term survival.
