Introduction: Liver transplantation (LT) is an established therapy for children with end-stage liver disease or liver failure. LT in small babies remains challenging due to lack of donor organs and the technical difficulties. This study aims to evaluate the outcomes of pediatric LT according to body weight of recipients.

Materials and Methods: Since 8 December 1988, of 552 LT performed 266 were children, 70 of whom were less than 10 kg. We reviewed their medical records for: primary cause of liver failure, age, weight at time of transplant, graft type, and medical outcomes of recipient and donor. 3 were deceased donor and 67 were living donor liver transplants (LDLT). The left lateral segment (Couinaud segments II and III) was used for LDLT. At our institution we perform hepatic arterial anastomoses by means of a corner saving technique. The arterial anastomosis is usually performed between the recipient hepatic artery, the gastroduodenal artery junction, and the left hepatic artery of the graft. All patients received tacrolimus-based immunosuppression.

Results: 34 were girls and 36 were boys with a mean age of 8.9±2.8 months (range, 3–18 months); mean weight at time of transplant was 7.2±1.3 kg (range, 4–10 kg). Median graft-to-recipient weight ratio was 4.2%±1.4% (range, 2.1–6.6%). In 43 patients hepaticojejunostomy biliary reconstruction, in 23 patients duct-to-duct biliary reconstruction and in 4 patients EPTFE graft biliary reconstruction was performed. During the early postop period, hepatic arterial thrombosis was identified in 8 patients, portal vein thrombosis in 1 patient and biliary leak in 7 patients. In 9 patients, the abdomen was closed with a Bogota bag, which were all closed in 2 weeks. In 2 patients portal vein stenosis was identified during the late postop period. Biliary stenosis was revealed in 17 patients. The 1-year and 5-year survival rates were 88.5% and 81.4% respectively. There were 13 patients who died during follow-up period. Six patients died at the early stage of transplantation (sepsis 4; ARDS 2). Seven patients died at the late follow-up period (sepsis 4; chronic rejection 2; cranial hemorrhage 1). There was no major donor morbidity or donor mortality.

Conclusions: Our data confirmed that living-related donors provide a reliable source for the organ pool and satisfactory results can be achieved despite the anatomic handicaps of this age group.

CITATION INFORMATION: Akdur A, Moray G, Ozcay F, Torgay A, Haberal M. Liver Transplantation for Babies Weighing Less Than 10 kg. Am J Transplant. 2017;17 (suppl 3).

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