Adult liver transplantation using pediatric donor livers after cardiac or brain death: A report of three cases

Ding,Limin; Deng,Lishan; Li,Xinchang; Xu,Zhidan

doi:10.3892/etm.2020.9155

Adult liver transplantation using pediatric donor livers after cardiac or brain death: A report of three cases

Authors:
- Limin Ding
- Lishan Deng
- Xinchang Li
- Zhidan Xu
View Affiliations

Affiliations: Department of Transplantation, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi 330000, P.R. China, Secretarial Section, Jiangxi Provincial Cultural and Sports Management Center for the Disablede, Nanchang, Jiangxi 330000, P.R. China
Published online on: August 31, 2020 https://doi.org/10.3892/etm.2020.9155
Article Number: 27
Copyright: © Ding et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The present study reports on the experience at Jiangxi Provincial People's Hospital (Nanchang, China) with liver transplantation in adults using pediatric donor livers, including indications, technique and results. A total of three cases of liver transplantation performed between April 2008 and May 2016 were retrospectively reviewed. Liver procurement and trimming, recipient selection, surgical tips, prevention and treatment of small‑for‑size syndrome, selection of immunosuppressive regimens, prevention and treatment of vascular complications and anticoagulant therapy were discussed. The three pediatric donors were 8, 8 and 10 years old. The three recipients were confirmed to have primary liver cancer. In recipient 1 (female; age, 39 years), jaundice persisted in the recipient after the liver transplantation. A reduced dose of FK506 was then given to gradually decrease the total bilirubin level to the normal range. Recipient 1 recovered and was discharged from hospital; however, the patient died of liver cancer recurrence and bone metastasis 6 years post‑transplantation. In recipient 2 (male; age, 56 years), the recipient experienced sudden abdominal distension on postoperative day 7. The patient's clotting time was prolonged and the transaminase level was sharply increased, peaking on day 9. The patient was suspected of having small‑for‑size syndrome and was treated symptomatically. The patient experienced a significant improvement in symptoms on postoperative day 13 and regular postoperative follow‑ups were performed until now and the patient is now in remission. In recipient 3 (male; age, 48 years), the recipient recovered well and the liver function returned to normal on postoperative day 3. The patient was discharged from hospital and has been in remission thus far. Adult liver transplantations from pediatric donors are feasible treatments. Systematic donor and recipient assessments, sound surgical skills and optimal postoperative treatments are essential for success in the transplantation of livers from pediatric donors into adult recipients. Considering the condition of the donor liver, the selection of recipients and appropriate surgical methods are particularly important in these cases.

View Figures

View References

1	Chen ZH: New sight after a quarter century: A long Chinese way to tackle the organ shortage in the era of worldwide organ crises. Zhonghua Yizhi Zazhi Diziban. 4:265–272. 2010.
2	Zhang L, Zeng L, Gao X, Wang H and Zhu Y: Transformation of organ donation in China. Transpl Int. 28:410–415. 2015.PubMed/NCBI View Article : Google Scholar
3	Zhang GY, Liao T, Fu XB and Li QF: Organ transplantation in China: Concerns remain. Lancet. 385:854–855. 2015.PubMed/NCBI View Article : Google Scholar
4	Yan LN: Modern Liver Transplantation. 1st edition. Beijing, Military science publishing house, pp292-306, 2004.
5	Organ Transplantation Branch of the Chinese Medical Association. National guidelines for donation after cardiac death in China (2nd edition). Zhonghua Qiguanyizhi Zazhi 32: 756-758, 2011.
6	Shen XM: Clinical Pediatrics. 1st edition. People's Medical Publishing House, Beijing, pp1010-1011, 2005.
7	Werner MJM, van Leeuwen OB, de Jong IEM, Bodewes FAJA, Fujiyoshi M, Luhker OC, Scheenstra R, de Vries Y, de Kleine RHJ and Porte RJ: First report of successful transplantation of a pediatric donor liver graft after hypothermic machine perfusion. Pediatr Transplant. 23(e13362)2019.PubMed/NCBI View Article : Google Scholar
8	Croome KP, Lee DD, Burns JM, Saucedo-Crespo H, Perry DK, Nguyen JH and Taner CB: Mayo Clinic Collaborative in Transplant Research and Outcomes: Outcomes of liver transplantation with liver grafts from pediatric donors used in adult recipients. Liver Transpl. 22:1099–1106. 2016.PubMed/NCBI View Article : Google Scholar
9	He XS, Ju WQ, Guo ZY, Wu LW, Tai Q, Han M, Wang DP, Zhu XF and Huang JF: First case of pediatric donor liver for adult liver transplantation in China. Zhonghua Waike Zazhi. 48:1597–1598. 2010.
10	Shi J, Luo WF, Ding LM, Xu ZD, Wang YG, Li XC, Luo LB and Long CM: Clinical analysis of liver transplant from a child of brain death to an adult. Zhonghua Gandan Waike Zazhi. 17:359–363. 2011.
11	Wei L, Zhu ZJ, Dong C, Gao W, Yang T, Sun LY, Qu W, Rao W, Sun XY and Shen ZY: Use of liver graft from pediatric donor of donation after cardiac death in adult recipient (report of one case). Zhongguo Puwai Jichu Yu Linchuang Zazhi. 19:490–492. 2012.
12	Huang XL, Li GQ, Mu XX, Qin JJ, Zhou S, Li MY, Pang XX Tan and SB and Sun PC: Preliminary experience of pediatric donor liver and advanced marginal donor liver in adult liver transplantation. Nanjing Yike Daxue Xuebao (Ziranban). 36193–196. (209)2016.
13	Lan C, Song JL, Yan LN, Yang JY, Wen TF, Li B and Xu MQ: Pediatric donor to adult recipients in donation after cardiac death liver transplantation: A single-center experience. Transplant Proc. 49:1383–1387. 2017.PubMed/NCBI View Article : Google Scholar
14	Ju W, Li C, Zhang C, Ko DS, Wang D, Han M, Schroder PM, Wang X, Jiao X, Wu L, et al: Outcome of the use of paediatric donor livers in adult recipients: A single Chinese Centre experience. Clin Res Hepatol Gastroenterol. 43:148–154. 2019.PubMed/NCBI View Article : Google Scholar
15	Li JJ, Zu CH, Li SP, Gao W, Shen ZY and Cai JZ: Effect of graft size matching on pediatric living-donor liver transplantation at a single center. Clin Transplant: 32, 2018. doi: 10.1111/ctr.13160.
16	Yasutomi M, Harmsmen S, Innocenti F, DeSouza N and Krom RA: Outcome of the use of pediatric donor livers in adult recipients. Liver Transpl. 7:38–40. 2001.PubMed/NCBI View Article : Google Scholar
17	Emre S, Soejima Y, Altaca G, Facciuto M, Fishbein TM, Sheiner PA, Schwartz ME and Miller CM: Safety and risk of using pediatric donor livers in adult liver transplantation. Liver Transpl. 7:41–7. 2001.PubMed/NCBI View Article : Google Scholar
18	Zhang R, Zhu ZJ, Sun LY, Wei L and Qu W: Outcomes of liver transplantation using pediatric deceased donor livers: A single-center analysis of 102 donors. Chin Med J (Engl). 131:677–683. 2018.PubMed/NCBI View Article : Google Scholar
19	Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC and Williams R: Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 60:646–649. 1973.PubMed/NCBI View Article : Google Scholar
20	Shore PM, Huang R, Roy L, Darnell C, Grein H, Robertson T and Thompson L: Potential for liver and kidney donation after circulatory death in infants and children. Pediatrics. 128:e631–e638. 2011.PubMed/NCBI View Article : Google Scholar
21	Gu L, Fang H, Li F, Zhang S, Shen C and Han L: Impact of hepatic arterial hemodynamics in predicting early hepatic arterial thrombosis in pediatric recipients younger than three yr after living donor liver transplantation. Pediatr Transplant. 19:273–278. 2015.PubMed/NCBI View Article : Google Scholar
22	Ackermann O, Branchereau S, Franchi-Abella S, Pariente D, Chevret L, Debray D, Jacquemin E, Gauthier F, Hill C and Bernard O: The long-term outcome of hepatic artery thrombosis after liver transplantation in children: Role of urgent revascularization. Am J Transplant. 12:1496–503. 2012.PubMed/NCBI View Article : Google Scholar
23	Gu LH, Fang H, Li FH, Li P, Zhu CX, Zhu JJ and Zhang SJ: Prediction of early hepatic artery thrombosis by intraoperative color Doppler ultrasound in pediatric segmental liver transplantation. Clin Transplant. 26:571–576. 2012.PubMed/NCBI View Article : Google Scholar
24	Guo WZ, Zhang JK, Cao SL, Wang ZH, Wen PH, Shi XY, Yang H, Chen CQ and Zhang SJ: Experience of pediatric organ procurement and bench surgery from donation after citizen's death. Shiyong Qiguan Yizhi Dianzi Zazhi. 5:11–14. 2017.
25	Urata K, Hashikura Y, Ikegami T, Terada M and Kawasaki S: Standard liver volume in adults. Transplant Proc. 32:2093–2094. 2000.PubMed/NCBI View Article : Google Scholar
26	Chan SC, Liu CL, Lo CM, Lam BK, Lee EW, Wong Y and Fan ST: Estimating liver weight of adults by body weight and gender. World J Gastroenterol. 12:2217–2222. 2006.PubMed/NCBI View Article : Google Scholar
27	Shimada M, Ijichi H, Yonemura Y, Harada N, Shiotani S, Ninomiya M, Yoshizumi T, Soejima Y, Suehiro T and Maehara Y: Is graft size a major risk factor in living-donor adult liver transplantation? Trans Int. 17:310–316. 2004.PubMed/NCBI View Article : Google Scholar
28	Lee HH, Joh JW, Lee KW, Kim SJ, Lee DS, Park JH, Choi SH, Heo JS, Hyon WS, Kwak MS and Lee SK: Small-for-size graft in adult living-donor liver transplantation. Transplant Proc. 36:2274–2276. 2004.PubMed/NCBI View Article : Google Scholar
29	Tannuri U, Mello ES, Carnevale FC, Santos MM, Gibelli NE, Ayoub AA, Maksoud-Filho JG, Velhote MC, Silva MM, Pinho ML, et al: Hepatic venous reconstruction in pediatric living-related donor liver transplantation-experience of a single center. Pediatr Transplant. 9:293–298. 2005.PubMed/NCBI View Article : Google Scholar
30	Yang DS, Chen JJ, Lu Q, Huang ZY and Yang GD: Complicated bile duct stricture and its surgical treatment. Zhonghua Gandan Waike Zazhi. 9:73–75. 2003.
31	Tanaka K and Ogura Y: ‘Small-for-size graft’ and ‘small-for-size syndrome’ in living donor liver transplantation. Yonsei Med J. 45:1089–1094. 2004.
32	Marcos A: Right lobe living donor liver transplantation: A review. Liver Transpl. 6:3–20. 2000.PubMed/NCBI View Article : Google Scholar
33	Adam R, Castaing D and Bismuth H: Transplantation of small donor livers in adult recipients. Transplant Proc. 25:1105–1106. 1993.PubMed/NCBI
34	Gondolesi GE, Florman S, Matsumoto C, Huang R, Fishbein TM, Sheiner PA, Schwartz ME, Emre S, Thung S, Shapiro R and Miller CM: Venous hemodynamics in living donor right lobe liver transplantation. Liver Transpl. 8:809–813. 2002.PubMed/NCBI View Article : Google Scholar
35	Man K, Lo CM, Ng IO, Wong YC, Qin LF, Fan ST and Wong J: Liver transplantation in rats using small-for-size grafts: A study of hemodynamic and morphological changes. Arch Surg. 136:280–285. 2001.PubMed/NCBI View Article : Google Scholar
36	Hill MJ, Hughes M, Jie T, Cohen M, Lake J, Payne WD and Humar A: Graft weight/recipient weight ratio: How well does it predict outcome after partial liver transplants? Liver Transpl. 15:1056–1062. 2009.PubMed/NCBI View Article : Google Scholar
37	Campos BD and Botha JF: Strategies to optimize donor safety with smaller grafts for adult-to-adult living donor liver transplantation. Curr Opin Organ Transplant. 17:230–234. 2012.PubMed/NCBI View Article : Google Scholar
38	Zhang YH, Zhang R and Xu J: Clinical observation for hemodynamic changes of children DCD donor liver in adult recipients during early stage. Shiyong Qiguan Yizhi Dianzi Zazhi. 5:359–362. 2017.
39	Mack DR, Traystman MD, Colombo JL, Sammut PH, Kaufman SS, Vanderhoof JA, Antonson DL, Markin RS, Shaw BW Jr and Langnas AN: Clinical denouement and mutation analysis of patients with cystic fibrosis undergoing liver transplantation for biliary cirrhosis. J Pediatr. 127:881–887. 1995.PubMed/NCBI View Article : Google Scholar
40	Noble-Jamieson G, Valente J, Barnes ND, Friend PJ, Jamieson NV, Rasmussen A and Calne RY: Liver transplantation for hepatic cirrhosis in cystic fibrosis. Arch Dis Child. 71:349–52. 1994.PubMed/NCBI View Article : Google Scholar
41	Song YW, Zhu ZJ, Sun LY, Wei L, Qu W, Zeng ZG and Liu Y: Clinical study on growth and development of children after liver transplantation. Qiguan Yizhi. 235–239. 2015.
42	Li LB, Chen YM, Zhang SN, Gao Y, Ren G, Zhang CP, Xiong G and Ma J: Combination of terlipressin and FK409 for protection against small-for-size syndrome in living donor liver transplantation. Zhongwai Jiankang Wenzhai. 25–27. 2014.
43	Mo LQ, Yuan BL, Xiao Y, Xiao LC, Xu KQ and Huang WQ: Effects of terlipressin on hemodynamics and renal function in cirrhotic patients undergoing orthotopic liver transplantation. Shiyong Yixue Zazhi. 23:2461–2463. 2007.
44	Fung JJ and Starzl TE: FK506 in solid organ transplantation. Ther Drug Monit. 17:592–595. 1995.PubMed/NCBI View Article : Google Scholar
45	Spada M, Corno V, Colledan M, Segalin A, Lucianetti A, Torre G, Riva S, Sonzogni A, Petz W and Gridelli B: Rejection and tacrolimus conversion therapy in paediatric liver transplantation. Transpl Int. 13 (Suppl 1):S341–S344. 2000.PubMed/NCBI View Article : Google Scholar
46	van Hooff JP and Christiaans MH: Use of tacrolimus in renal transplantation. Transplant Proc. 31:3298–3299. 1999.PubMed/NCBI View Article : Google Scholar
47	Crespo-Leiro MG: Tacrolimus in heart transplantation. Transplant Proc. 35:1981–1983. 2003.PubMed/NCBI View Article : Google Scholar
48	Yan LZ, Chen L, Wang LJ and Lu YX: Metabolic differences between tacrolimus in adult and child carcasses and living donor liver transplant recipients. Wujing Houqin Xueyuan Xuebao (Yixueban). 23:578–582. 2014.
49	Neuhaus P, Blumhardt G, Bechstein WO, Platz KP, Jonas S, Mueller AR, Langrehr JM, Lohmann R, Schattenfroh N, Knoop M, et al: Comparison of FK506- and cyclosporine-based immunosuppression in primary orthotopic liver transplantation. A single center experience. Transplantation. 59:31–40. 1995.PubMed/NCBI View Article : Google Scholar
50	Flanagan WM, Corthésy B, Bram RJ and Crabtree GR: Nuclear association of a T-cell transcription factor blocked by FK-506 and cyclosporin A. Nature. 352:803–807. 1991.PubMed/NCBI View Article : Google Scholar
51	Ameyaw MM, Regateiro F, Li T, Liu X, Tariq M, Mobarek A, Thornton N, Folayan GO, Githang'a J, Indalo A, et al: MDR1 pharmacogenetics: Frequency of the C3435T mutation in exon 26 is significantly influenced by ethnicity. Pharmacogenetics. 11:217–221. 2001.PubMed/NCBI View Article : Google Scholar
52	Jain A, Venkataramanan R, Sharma R, Kwong T, Orloff M, Abt P, Kashyap R, Tsoulfas G, Batzold P, Williamson M and Bozorgzadeh A: Pharmacokinetics of tacrolimus in living donor liver transplant and deceased donor liver transplant recipients. Transplantation. 85:554–560. 2008.PubMed/NCBI View Article : Google Scholar