Living related liver transplantation in infants and children: report of anesthetic care and early postoperative morbidity and mortality

Study Objective: To determine those infants at high risk for perioperative complications and mortality following living, related liver transplantation. Design: Retrospective chart review. Setting: Large metropolitan teaching hospital. Measurements and Main Results: The charts and anesthetic records...

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Bibliographic Details
Published in:Journal of clinical anesthesia 2000-09, Vol.12 (6), p.454-459
Main Authors: Wagner, Claudia, Beebe, David S, Carr, Richard J, Komanduri, Vijaya, Humar, Abhinav, Gruessner, Ranier W, Belani, Kumar G
Format: Article
Language:English
Subjects:
Abdominal surgery. Urology. Gynecology. Obstetrics
Anesthesia
Anesthesia - methods
Anesthesia depending on type of surgery
anesthesia, complications
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Child
Child, Preschool
Female
Humans
Infant
Liver Transplantation - adverse effects
Liver Transplantation - mortality
living, related liver transplantation
Male
Medical sciences
Morbidity
mortality, pediatric
Postoperative Complications - etiology
Thrombosis - etiology
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Summary:Study Objective: To determine those infants at high risk for perioperative complications and mortality following living, related liver transplantation. Design: Retrospective chart review. Setting: Large metropolitan teaching hospital. Measurements and Main Results: The charts and anesthetic records of the 12 infants and children who received the left lateral hepatic segment from a living relative the past 2 years at our institution were reviewed. The records were examined to determine the causes of perioperative morbidity and to identify patients at high risk for serious complications and mortality. All infants and children (mean ± SD age, 29 ± 30 months; weight, 13.6 ± 6.8 kg) survived the operation (8.3 ± 1.7 hours) without intraoperative complications. The average blood loss, including 500 mL of recipient blood used to flush the liver before reperfusion, was 1483 ± 873 mL (119 ± 70 mL/kg). Three infants developed portal vein thrombosis, and one of these infants also had hepatic artery thrombosis. The risk of vessel thrombosis was significantly higher (3/3 vs. 0/9; p < 0.0045) in infants less than 9 kg body weight, as was the risk of death (2/3 vs. 0/9; p < 0.045). Both children who died had vascular thrombosis. Other serious complications were bleeding, 6; infection, 7; acute rejection, 3; and bile leak, 2. Conclusions: Infants and children can successfully undergo living, related liver transplantation. However, the risks of vascular complications and death are greater in infants less than 9 kg body weight.
ISSN:0952-8180
1873-4529
DOI:10.1016/S0952-8180(00)00192-6