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- W2326112832 abstract "Aim: To assess the indications, surgical strategies and outcome of pediatric patients after living donor liver transplantation (LDLT). Methods: Retrospective analysis of prospectively collected data of 104 LDLT in 103 pediatric patients from August 2004 to December 2012. Results: LDLT done on 103 patients, 61 males mean age of 72.1 months (5 mths-17yrs) mean weight 20.9Kg (4.5-66). Indications were chronic liver disease (CLD) in 64 which cholestasis in 51 (76%), 34 acute,primary hyperoxaluria 2, maple syrup urine disease 2, giant cavernous hemangioma 1 and factor 7 deficiency 1. Parents were the donors in 66, close relatives in 31. 5 swap donors, 2 domino graft. Grafts included left lateral 49(46%) of which 17 were reduced, left lobe 39(39%), right lobe 14(13%) and whole liver in 2 cases (domino). All transplants were done in piggyback fashion. PV extension was done in 6 and hemi-cavoportal transposition in 2 patients. In 3 patients, mesh closure was done to accommodate the graft. Cold and Warm Ischemic Time were 82.6 + 72.6 and 49.8 + 23 respectively. 29% of children less than 10 Kg had vascular complications in comparison to 5.4 % in more than 10 Kg group (73). Mean hospital stay was 26.5 days (7 - 63). Laproscopic and robotic surgery was done 2 and 4 respectively. Portal vein thrombosis was seen in 6,5 of 6 patients of Portal vein thrombosis were reexplored for the same 1 managed conservatively. Late PV stenosis seen in 2 for which stenting was done by interventional radiologist (IR), 3 had hepatic artery thrombosis (HAT) – 2 died, 1 underwent left iliac to HA conduit.15 (14.6%) had biliary compliation. Biliary strictures were seen in 6, 4 underwent stenting across the stricture by IR, 1 endoscopic stenting 1 surgical reanastomosis. 4 patients had chronic rejection, all died. Overall survival – 85% in <10kg in comparison to 91% in >10 kg on mean follow up of 30 months. Conclusion: Pediatric LDLT is well established in India with results comparable to the best centers in world. LDLT in children < 10 kg often necessitates technical modifications such as portal venoplasty / extension, graft reduction, mesh closure and microvascular reconstruction. With advances in interventional radiology and endoscopic techniques, these are emerging as the preferred treatment options even in children, obviating the need for surgery in a selected majority of patients. Outcome in <10kg was not significantly different. Vascular complications are more in <10 kg group biliary complications were more in > 10 Kg group. Early portal vein issues could be managed surgically while late portal vein issues were managed by interventional radiology. Similarly, IR was used in vast majority of biliary complications. The outcome in <10 kg was slightly inferior to be overall outcome." @default.
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- W2326112832 date "2013-03-01" @default.
- W2326112832 modified "2023-09-29" @default.
- W2326112832 title "Lessons learnt from the first century of pediatric liver transplantation in India" @default.
- W2326112832 doi "https://doi.org/10.1016/j.jceh.2013.03.194" @default.
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