Comparison of the incidence of reperfusion syndrome and outcomes of liver transplantation among pediatric recipients of partial vs. whole graft: report of six-year retrospective study.

BACKGROUND

Advancements in graft selection, surgical and anesthetic techniques have improved the outcomes of pediatric liver transplantation over the last few decades. In this study, we evaluate preoperative factors, the incidence of post-reperfusion syndrome, rejection, and survival among 523 pediatric patients who received whole vs. partial liver transplantation.

METHODS

In a six-year retrospective observational study on 523 pediatric liver transplantation recipients (age < 18 years old) in Abu-Ali Sina Organ Transplantation Hospital, we collected recipients' demographic data, warm and cold ischemic time, post reperfusion syndrome, and postoperative outcomes, including mechanical ventilation time, ICU length of stay, acute renal failure, acute cellular rejection, re-transplantation, and patients' survival. We compared these preoperative, operative, and postoperative outcomes among whole and partial graft recipients using SPSS software for Windows.

RESULTS

259 cases received partial and 264 cases received whole organ transplantation. We compared the donor factors, preoperative, intraoperative recipient factors, and postoperative outcomes between the two groups. The donors' age and percentage of macrovesicular steatotic changes of the partial donor graft were significantly higher than the whole donor graft, respectively (33.5 vs. 6,p < 0.001) (31% vs. 17%,p < 0.001). The recipients of partial graft had younger age (3.5 (1.5-8) vs. 9 (5-14) years, P < 0.001) than recipients of whole organ graft. Although partial organ recipients had shorter cold ischemic time (25 (15-30) vs. 480 (390-570) minutes, P < 0.001), they significantly developed post-reperfusion syndrome more than whole organ recipients (14% vs. 7.5%, P = 0.01). The outcome of partial organ recipients also seemed to be poorer compared with whole organ recipients; they had longer ICU stays (18 (11-29) vs. 14 (9-20) days, P = 0.004) and lower survival (61.4% vs. 81.8%, P < 0.001).

CONCLUSION

Although partial organ transplantation provides more chances for pediatric liver transplant candidates to survive, we observed that physicians have faced many challenges, and children had more complications and lower survival after partial organ transplantation.