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Liver 2

Monday March 27, 2023 - 10:00 to 11:00

Room: Hill Country AB

306.1 Impact and outcomes after optimization of liver bipartition in pediatric liver transplantation

Ane Andres, Spain

Pediatric transplant surgeon
Pediatric Surgery
Hospital La Paz


Impact and outcomes after optimization of liver bipartition in pediatric liver transplantation

Ane Andres1, Esteban Frauca2, Javier Serradilla1, Gema Muñoz-Bartolo2, Maria José Quiles2, Alba Sanchez-Galan1, Jose Luis Encinas1, Maria Alos-Diez2, Alba Bueno1, Karla Estefania1, Maria Velayos1, Loreto Hierro2, Francisco Hernandez-Oliveros1.

1Pediatric Surgery, Hospital La Paz, Madrid, Spain; 2Pediatric Hepatology, Hospital La Paz, Madrid, Spain

Aim: To present our experience and impact of the optimization of liver grafts by prioritizing the pediatric recipient, promoting bipartition (Split).
Patient and methods:   We reviewed the pediatric liver transplant series in our center (n=831; 1986-2022), focusing on split grafts. We compared the historical series (Period 1: 1994-April 2019) with the last 3 years (Period 2: April 2019- August 2022) and analyzed its impact on living related donor liver transplantation (LRDLT). Demographic data, technical resources for bipartition and implantation, and outcomes were also recorded. 
Results: There were 26 bipartitions in period 2 (26.8%, only one urgent) compared to 52 in period 1 (6.6%, 71% urgent). The main indication was biliary atresia (58%), with a median of 12.3 months (range 0.9-89) and 8.1 kg (range 3.1-21.9). The left hepatic lobe (median 290 g) was used, leaving the right lobe for the adult team. The median age/weight/hours in the ICU of the donor were 26 years/67 kg/24h, respectively.
Twelve adult centers participated in the bipartition (16 in-situ, 10 ex-situ). In 18 (73%) we kept the left and proper hepatic artery, leaving the right hepatic artery, common hepatic artery and celiac trunk for the right graft (with reconstruction).
Among the technical difficulties derived from the bipartition, the following stood out: double suprahepatic anastomosis (1), venous grafts from the graft surface (2) cava substitution with a jugular graft (1), dissection of the pericardium (2), interposition of venous grafts between superior mesenteric and portal veins (7 cases, Kanazawa technique in 2), donor iliac artery grafts to the infrarenal aorta (8), and double bile duct (7). Eleven required delayed closure of the abdominal wall.
The transplant was 100% successful (12/52 grafts had been lost in period 1, 23%); a biliary fistula and an arterial thrombosis were resolved surgically; on the long term one patient died for reasons unrelated to the transplant.
To our knowledge, all right liver grafts were successfully implanted, except for two that required retransplantation and one which was not finally used. The LRDLT/ Split ratio decreased significantly (p<0.05): 36:1 between 2016-2019 vs 8:26 between 2019-2022.   The biliary complications rate also decreased in the new Split era compared with the LRDLT group.
Conclusion: Bipartition has quadrupled in our pediatric liver transplant program, with excellent results and a reduction in the need for a living donor, ceasing to be just an emergency option. The in-situ technique and an adequate distribution of the artery are advantages that benefit both teams.

Organización Nacional de Trasplantes (ONT); HEPA (Spanish Association of Pediatric Patients with Liver Disease and Liver Transplantation).

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