Tuesday July 03, 2018 from 16:30 to 17:30
Laparoscopic Approach for Living Donor to Paediatric Liver Transplantation. Experience of the First 7 Cases in Spain
Javier Briceño1, Ruben Ciria1, Pedro Lopez-Cillero1, Maria Dolores Ayllon1, Irene Gomez-Luque1, Antonio Luque1, Juan Manuel Sanchez-Hidalgo1, Alvaro Arjona1, Sebastian Rufian1, Jesus Jimenez-Gomez2.
1General Surgery. Hepatobiliary and Liver-Pancreas transplantation Unit., University Reina Sofia Hospital, Cordoba, Spain; 2Gastroenterology diseases and Pediatric liver Unit, University Reina Sofia Hospital, Cordoba, Spain
Introduction: Our paediatric liver transplantation program started on 1990 and at present has performed more than 170 children's liver transplants. In the last year, laparoscopic approach was first used. Seven cases of living donor with laparoscopic approach were performed; one of them was an auxiliary liver transplant.
Objectives: In this study we report our series of seven cases of living donor liver transplantation (LDLT), one of them auxiliary, performing left lateral sectorectomy with a pure laparoscopic approach.
Results: Seven pure laparoscopic LDLT from March to February 2017 were performed. The average age of donors was 33,29 (27-43) years. Six of the donors were women and 1 male. The mean BMI of the donors was 21,96 (18,38-27,47). 60% were ASA I and 40% ASA II. Pre-tx liver function was normal in all donors. Only three donors required Pringle maneuver (3, 2 and 2 cycles respectively – 30, 25 and 25 min each one). The mean age of the recipients was 2,61 (4-12) months with an average weight of 11,85 (6,6-31) kg. The aetiology was biliary atresia in 4 of them, metabolic disorders in the other two (OTC Deficit) and Alagille Syndrome in other. In one case, an urgent transplant was performed due to worsening of the liver function of the recipient. The surgical time of donor surgery was 363,6 (255-410) min and the recipient's time was 403,6 (240-560) min. The warm ischemia time (WIT) was 8,57 (6-15) min; cold ischemia time was (CIT) 77,3 (40-101) min. The conversion rate was 0%. Dindo-Clavien complications of donors were type I in three donors (42,9%), persistence of abdominal pain that required analgesia, emetic syndrome and re-admission due to dysnea where pulmonary thromboembolism was discarded and the donor was discharged after 48 hours. The donor CCI was 3,72 (0-87). The recipient CCI of our series was 26,34 (20,9-46,2); in two cases reoperation was required (in auxiliary transplant to perform portal flow remodulation and in Sd. Alagille due to kinking of the graft for relocation; which, finally, precise of retransplantation). The mean stay of the recipients was 22.8 ± 7.9 (14-33) days and the donors was 4.4 ± 1.5 (3-6) days. Perioperative donor and recipient mortality was 0%. To date with a mean follow-up of 11,4 (6-19) months, our series has a survival rate of 100% and a recurrence rate of 0%.
Conclusions: We can propose the laparoscopic approach in reference centers as "standard to practice" due to its minimal complication rate and short hospital stay. Laparoscopic liver surgery is an emerging reality and minimally invasive approach to living donor can be considered a safe and effective procedure.