- Liver transplantation in children: pre-transplantation preparation tactics
Liver transplantation in children: pre-transplantation preparation tactics
Paediatric Surgery (Ukraine). 2025. 1(86): 40-44. doi: 10.15574/PS.2025.1(86).4044
Kurylo H. V.1,2
1Danylo Halytskyy Lviv National Medical University, Ukraine
2CNE "Lviv Territorial Medical Association "Multidisciplinary Clinical Hospital of Intensive Treatment Methods and Emergency Medical Care", Children's Surgery Center of the Separate Unit "Saint Nicholas Hospital", Ukraine
For citation: Kurylo HV. (2025). Liver transplantation in children: pre-transplantation preparation tactics. Paediatric Surgery (Ukraine). 1(86): 40–44. doi: 10.15574/PS.2025.1(86).4044.
Article received: Jan 07, 2025. Accepted for publication: Mar 18, 2025.
Liver transplantation (LT) from a living related donor is the only life-saving option for children with congenital liver diseases such as biliary atresia, Alagille syndrome, progressive familial intrahepatic cholestasis, and Byler disease, as well as metabolic disorders and acute or chronic liver failure. The development of LT from living related donors significantly reduces the waiting time for a donor organ. The success of the procedure largely depends on the quality of pre-transplantation preparation (PTP) of both donor and recipient.
Aim – to study the features of PTP in children with cholestatic liver diseases for successful LT.
Materials and methods. 37 children with biliary atresia underwent PTP between 2005 and 2023. In 36 cases, LT was performed using a living related donor; in one case, split-liver transplantation (SPLIT-LT) was used. PTP lasted 3–6 months and included infection focus sanitation, correction of congenital anomalies, emergency status assessment, and evaluation of physical and psycho-emotional development. All examinations followed current international standards.
Results. All transplantations were successful. After PTP, improvements were observed in hematological parameters, functional and neuropsychological development, and reduced anxiety levels. All transplant centers acknowledged the high quality of PTP; no child was refused transplantation due to inadequate preparation. The key readiness criteria were a compensated clinical state and a safe bacterial environment.
Conclusions. Compliance with regulatory standards and protocols for PTP ensures successful pediatric LT and protects donor health. PTP improves hematological, somatic, and psycho-emotional indicators, reduces risks, and increases the effectiveness of transplantation. Our experience with PTP aligns with international standards.
The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of the child and child's parents was obtained for the research.
No conflict of interest was declared by the author.
Keywords: biliary atresia, chronic cholestasis, donor, recipient, children, liver transplantation, pre-transplantation preparation.
REFERENCES
1. Antala S, Taylor SA. (2022, Aug). Biliary Atresia in Children: Update on Disease Mechanism, Therapies, and Patient Outcomes. Clin Liver Dis. 26(3): 341-354. Epub 2022 Jun 25. https://doi.org/10.1016/j.cld.2022.03.001; PMid:35868678 PMCid:PMC9309872
2. Au KP, Chan SC, Chok KS, Chan AC, Wong TC et al. (2015, Nov). Sharr WW, Lo CM. Durability of small-for-size living donor allografts. Liver Transpl. 21(11): 1374-1382. https://doi.org/10.1002/lt.24205; PMid:26123155
3. Au KP, Chok KSH. (2022, Sep 30). Anatomical limits in living donor liver transplantation. Korean J Transplant. 36(3): 165-172. Epub 2022 Jul 22. https://doi.org/10.4285/kjt.22.0023; PMid:36275985 PMCid:PMC9574428
4. Bech P. (2011). Measuring States of Anxiety with Clinician-Rated and Patient-Rated Scales [Internet]. Different Views of Anxiety Disorders. InTech. https://doi.org/10.5772/21246
5. Brahee DD, Lampl BS. (2022, Apr). Neonatal diagnosis of biliary atresia: a practical review and update. Pediatr Radiol. 52(4): 685-692. Epub 2021 Jul 31. https://doi.org/10.1007/s00247-021-05148-y; PMid:34331566
6. De Onis M. (2015). The WHO Child Growth Standards. World Rev Nutr Diet. 113: 278-294. https://doi.org/10.1159/000360352; PMid:25906897
7. Del Prete L, Quintini C, Diago Uso T. (2024, Oct 29). The small-for-size syndrome in living donor liver transplantation: current management. Updates Surg. Epub ahead of print. https://doi.org/10.1007/s13304-024-01964-7; PMid:39472379
8. European Association for the Study of the Liver. (2024, Dec). EASL Clinical Practice Guidelines on liver transplantation. J Hepatol. 81(6): 1040-1086. Epub 2024 Oct 31. https://doi.org/10.1016/j.jhep.2024.07.032; PMid:39487043
9. European Association for the Study of the Liver. (2016). EASL clinical practice guidelines: liver transplantation. J Hepatol. 64(2): 433-485. https://doi.org/10.1016/j.jhep.2015.10.006; PMid:26597456
10. Freeman RB Jr, Gish RG, Harper A, Davis GL, Vierling J, Lieblein L et al. (2006, Dec). Model for end-stage liver disease (MELD) exception guidelines: results and recommendations from the MELD Exception Study Group and Conference (MESSAGE) for the approval of patients who need liver transplantation with diseases not considered by the standard MELD formula. Liver Transpl. 12; 12 Suppl 3: S128-136. doi: 10.1002/lt.20979. Erratum in: Liver Transpl. 2008 Sep; 14(9): 1386. https://doi.org/10.1002/lt.20979; PMid:17123284
11. Glantz SA. (2012). Primer of Biostatistics, Seventh Edition. Stanton A. Glantz. McGraw-Hill Professional: 320.
12. Hackl C, Schmidt KM, Süsal C, Döhler B, Zidek M, Schlitt HJ. (2018, Dec 21). Split liver transplantation: Current developments. World J Gastroenterol. 24(47): 5312-5321. https://doi.org/10.3748/wjg.v24.i47.5312; PMid:30598576 PMCid:PMC6305537
13. Kim WR, Mannalithara A, Heimbach JK et al. (2021). Meld 3.0: the model for end-stage liver disease updated for the modern era. Gastroenterology. 161(6): 1887-1895.e1884. https://doi.org/10.1053/j.gastro.2021.08.050; PMid:34481845 PMCid:PMC8608337
14. Krowka MJ, Fallon MB, Kawut SM et al. (2016). International liver transplant society practice guidelines: diagnosis and management of hepatopulmonary syndrome and portopulmonary hypertension. Transplantation. 100(7): 1440-1452. https://doi.org/10.1097/TP.0000000000001229; PMid:27326810
15. Kurylo HV. (2024). Alagille syndrome in the clinical practice of a paediatric surgeon. Paediatric Surgery (Ukraine). 2(83): 49-56. https://doi.org/10.15574/PS.2024.83.49
16. Kurylo HV. (2024). Byler's disease: conservative and surgical treatment strategies. Paediatric Surgery (Ukraine). 3(84): 117-123. https://doi.org/10.15574/PS.2024.3(84).117123
17. Lau NS, Jacques A, McCaughan G, Crawford M, Liu K, Pulitano C. (2021, Jul). Addressing the challenges of split liver transplantation through technical advances. A systematic review. Transplant Rev (Orlando). 35(3): 100627. Epub 2021 May 19. https://doi.org/10.1016/j.trre.2021.100627; PMid:34052472
18. Ma KW, Wong KHC, Chan ACY, Cheung TT, Dai WC, Fung JYY et al. (2019, Sep 28). Impact of small-for-size liver grafts on medium-term and long-term graft survival in living donor liver transplantation: A meta-analysis. World J Gastroenterol. 25(36): 5559-5568. https://doi.org/10.3748/wjg.v25.i36.5559; PMid:31576100 PMCid:PMC6767984
19. Maydannyk VH, Burlay VH, Hnateyko OZ, Duka KD, Nechytaylo YuM. (2018). Propedevtychna pediatriya. Pidruch. dlya stud. vyshch. med. navch. zakl. IV rivnya akredytatsiyi. Za red. Maydannyk Vitaliy Hryhorovych. Vyd. 2-he, vypr. ta dopov. Vinnytsya: Nova knyha: 163.
20. Mazumder NR, Fontana RJ. (2024, Jan 29). MELD 3.0 in Advanced Chronic Liver Disease. Annu Rev Med. 75: 233-245. Epub 2023 Sep 26. https://doi.org/10.1146/annurev-med-051322-122539; PMid:37751367
21. McCormick A, Sultan J. (2005, Jul). Liver transplantation–patient selection and timing. Med J Malaysia. 60; Suppl B: 83-87. PMID: 16108182.
22. Ruf A, Dirchwolf M, Freeman RB. (2022, Jan-Feb). From Child-Pugh to MELD score and beyond: Taking a walk down memory lane. Ann Hepatol. 27(1): 100535. Epub 2021 Sep 22. https://doi.org/10.1016/j.aohep.2021.100535; PMid:34560316
23. Tam PKH, Wells RG, Tang CSM, Lui VCH, Hukkinen M, Luque CD et al. (2024, Jul 11). Biliary atresia. Nat Rev Dis Primers. 10(1): 47. https://doi.org/10.1038/s41572-024-00533-x; PMid:38992031
24. Weir CB, Jan A. (2023, Jun 26). BMI Classification Percentile And Cut Off Points. In: StatPearls.