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Living Donor Liver Transplantation in Children
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- Author(s) / Creator(s)
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Background
Liver transplantation is the definitive therapy for end stage liver disease in children. However, the number of cadaveric organs donated has remained relatively stable for many years, and the demand for cadaveric livers now far outstrips supply. Despite the development of innovative surgical techniques, such as reduced size liver
transplantation (RSLT) and split liver transplantation (SLT), the donor graft deficit
continues to grow. This has led to the search for new solutions, such as live donor liver
transplantation (LDLT), which was first successfully performed in 1989.
Adult to child LDLT is now routinely offered in many Western countries. The
purported advantages of LDLT include a shorter waiting time for a liver transplant; the ability to schedule the operation electively; reduced cold ischemic time for the donor liver; and increased availability of cadaver livers for patients still on the waiting list. There is also less likelihood of primary graft failure in the recipient since the graft is taken from a healthy, hemodynamically stable donor. However, donation of a liver
graft is associated with up to 0.3% mortality and 3% to 17% morbidity. The risks
incurred by LDLT donors, who are otherwise healthy, necessitate careful scrutiny of the
safety and efficacy of LDLT.
Objectives
To evaluate the published evidence on the safety, efficacy, and current status of living donor liver transplantation for the treatment of end stage liver disease in children.
Methodology
Data were collected on children (< 18 years of age) undergoing liver transplantation for any indication. All original, published systematic reviews, comparative studies with at least ten patients in each study arm, or case series studies reporting outcomes for at least ten donors were identified by searching electronic literature databases and the web sites of various health technology assessment agencies, research registers, and guidelines sites from 1995 to June 2004. No language restriction was applied.
Results
Donors
The LDLT donor operation is lengthy but rarely results in the need for blood
transfusion. On average, donors remain in hospital for at least five days. The mortality rate for live donors was 0.15%, and up to one in ten donors experience adverse effects ranging from bile leak and wound problems to more serious complications such as small bowel obstruction. As many as 4% of donors will undergo another operative procedure because of complications related to LDLT. IP21 Information Paper. ISBN 1-896956-99-8 (On-Line) -
- Date created
- 2004-08-01
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- Type of Item
- Report