P.229 The outcomes of split liver transplantation compared with living donor liver transplantation in pediatric patients
Sunday May 05, 2019 from 18:30 to 19:30
Exhibit-Poster Area
Presenter

Kyung Chul Yoon, Korea

Clinical Assistant Professor

Department of Surgery, Division of HBP Surgery and Liver Transplantation,

Korea University Medical Center, Korea University Medical College, Seoul, Korea

Abstract

The outcomes of split liver transplantation compared with living donor liver transplantation in pediatric patients

Kyung Chul Yoon1, Sanghee Song8, Jong Man Kim5, Ok-Kyung Kim3, Suk Kyun Hong2, Seak Hee Oh7, Nam-Joon Yi2, Kwang-Woong Lee2, Myoung Soo Kim6, Shin Hwang4, Kyung Mo Kim7, Kyung-Suk Suh2, Suk-Koo Lee5.

1Department of Surgery, Division of HBP Surgery and Liver Transplantation, Korea University Medical Center, Korea University Medical College, Seoul, Korea; 2Department of Surgery, Seoul National University College of Medicine, Seoul, Korea; 3Transplantation Center, Seoul National University Hospital, Seoul, Korea; 4Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea; 5Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, , Seoul, Korea; 6Department of Surgery and The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea; 7Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea; 8Transplantation center, Ewha Womans University Medical center, Seoul, Korea

Introduction:The number of the waiting list in pediatric patients has been decreased and more usage of the split liver transplantation (SLT) may substitute living donor liver transplantation (LDLT) in Korea. However, the outcomes of SLT and LDLT in Korea has not been yet reported.

Materials and Methods: A total of 93 pediatric patients received SLT in Korea between 2005 to 2014. Among them, the left lateral section was used in 47 patients for split liver transplantation(SLT) compared to 56 patients who received living donor liver transplantation (LDLT) using the same graft at Seoul National University Hospital.

Results and Discussion:The SLT group had more patients with recipients aged greater than 1 (59.6% vs. 39.3%) and the body weight was greater in the LDLT group [Median: 9.8 (5.3-49) vs. 14.5 (6-58), P=0.03]. The most common indication was biliary atresia with a similar proportion in both groups (68%). The PELD score was greater in the LDLT group [Median: 0 (-8.8 – 57.4) vs. 12.25 (-9 - 54), P=0.007] while the graft weight was higher in the SLT group [Median: 330 (280 – 640) vs. 290 (150 - 535), P=0.01]. Total ischemic time was longer in the SLT group (153 ± 72 vs. 102 ± 40, P=0.01). The median follow up period was 37 and 76 (months?) and the graft failure was 5 (10.6%) and 5 (8.9%) in the SLT and LDLT group respectively. The 1,3,5 year survival rate was 89.4%, 89.4%, 89.4% and 92.9%, 91%, 91% in the SLT and LDLT group respectively (P=0.728). Biliary complications were more common in the LDLT group (4.3% vs. 28.6%, P=0.001). However hepatic vein complications(4.3% vs. 16.1%, P=0.053), portal vein complications (10.6% vs. 14.3%, P=0.58), and the postoperative bleeding rate (4.3% vs. 10.7%, P=0.29) were not different in both groups. There were no significant risk factors for graft survival in the Cox regression model [SLT OR: 3.344 (0.564 – 19.984), P=0.183] using the following variables: recipient age, recipient sex, donor age, indication, PELD score, donor sex, and total ischemic time.

Conclusion:The graft survival rate of SLT and LDLT was not different in pediatric patients and the number of SLT is needed to expand to substitute living donors. Increasing the number of SLT can help to decrease the number of LDLT. 


Lectures by Kyung Chul Yoon


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