Failure to Rescue Pediatric Recipients of Living Donor Liver Transplantation: A Single-Center Study of Technical Complications in 500 Primary Grafts.
failure to rescue
immunological complication
living donor liver transplantation
pediatrics
technical complication
Journal
Pediatric transplantation
ISSN: 1399-3046
Titre abrégé: Pediatr Transplant
Pays: Denmark
ID NLM: 9802574
Informations de publication
Date de publication:
Nov 2024
Nov 2024
Historique:
revised:
28
08
2024
received:
08
08
2024
accepted:
08
09
2024
medline:
25
9
2024
pubmed:
25
9
2024
entrez:
25
9
2024
Statut:
ppublish
Résumé
The concept of failure to rescue (FTR) has been used to evaluate the quality of care in several surgical specialties but has not been well-studied after living donor liver transplantation (LDLT) in children. This study retrospectively reviewed 500 pediatric LDLT performed at a single center between 1993 and 2022. The recipient outcomes were assessed by means of patient and graft survival rates, retransplantation rates, and arterial/portal/biliary complication rates. Graft and patient losses secondary to these complications were calculated regarding FTR for patients (FTRp) and grafts (FTRg). Overall 1- and 5-year patient survival rates were 94.5% and 92.1%, respectively, the corresponding figures for graft survival being 92.7% and 89.8%. One-year hepatic artery complication rate was 3.6% (n = 18 cases), the respective rates for portal vein complications and biliary complications being 5.7% (n = 57) and 15.6% (n = 101). One-year FTRp rates for hepatic artery thrombosis, portal vein thrombosis, anastomotic biliary stricture, and intrahepatic biliary stricture were 28.6%, 9.4%, 3.6%, and 0%, respectively. The corresponding FTRg rates being 21.4%, 6.3%, 0%, and 36.4%. Such novel analytical method may offer valuable insights for optimizing quality of care in pediatric LDLT.
Sections du résumé
BACKGROUND
BACKGROUND
The concept of failure to rescue (FTR) has been used to evaluate the quality of care in several surgical specialties but has not been well-studied after living donor liver transplantation (LDLT) in children.
METHODS
METHODS
This study retrospectively reviewed 500 pediatric LDLT performed at a single center between 1993 and 2022. The recipient outcomes were assessed by means of patient and graft survival rates, retransplantation rates, and arterial/portal/biliary complication rates. Graft and patient losses secondary to these complications were calculated regarding FTR for patients (FTRp) and grafts (FTRg).
RESULTS
RESULTS
Overall 1- and 5-year patient survival rates were 94.5% and 92.1%, respectively, the corresponding figures for graft survival being 92.7% and 89.8%. One-year hepatic artery complication rate was 3.6% (n = 18 cases), the respective rates for portal vein complications and biliary complications being 5.7% (n = 57) and 15.6% (n = 101). One-year FTRp rates for hepatic artery thrombosis, portal vein thrombosis, anastomotic biliary stricture, and intrahepatic biliary stricture were 28.6%, 9.4%, 3.6%, and 0%, respectively. The corresponding FTRg rates being 21.4%, 6.3%, 0%, and 36.4%.
CONCLUSION
CONCLUSIONS
Such novel analytical method may offer valuable insights for optimizing quality of care in pediatric LDLT.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14861Informations de copyright
© 2024 Wiley Periodicals LLC.
Références
M. Gurevich, V. Guy‐Viterbo, M. Janssen, et al., “Living Donor Liver Transplantation in Children: Surgical and Immunological Results in 250 Recipients at Universite Catholique de Louvain,” Annals of Surgery 262, no. 6 (2015): 1141–1149.
F. C. Ryckman, A. W. Flake, R. A. Fisher, J. I. Tchervenkov, S. H. Pedersen, and W. F. Balistreri, “Segmental Orthotopic Hepatic Transplantation as a Means to Improve Patient Survival and Diminish Waiting‐List Mortality,” Journal of Pediatric Surgery 26, no. 4 (1991): 422–428.
J. B. Otte, J. de Ville de Goyet, and R. Reding, “Living Related Donor Liver Transplantation in Children: The Brussels Experience,” Transplantation Proceedings 28, no. 4 (1996): 2378–2379.
R. Reding, J. V. de Goyet, I. Delbeke, et al., “Pediatric Liver Transplantation With Cadaveric or Living Related Donors: Comparative Results in 90 Elective Recipients of Primary Grafts,” Journal of Pediatrics 134, no. 3 (1999): 280–286.
M. Rela and M. S. Reddy, “"Failure to Rescue" as a Novel Quality Metric in Pediatric Liver Transplantation,” Transplantation 100, no. 4 (2016): 707.
A. B. Hafeez Bhatti, F. S. Dar, A. I. Qureshi, et al., “Failure to Rescue in Living Donor Liver Transplantation: Patterns and Predictors,” International Journal of Surgery 44 (2017): 281–286.
S. L. Cramm, S. A. Waits, M. J. Englesbe, et al., “Failure to Rescue as a Quality Improvement Approach in Transplantation: A First Effort to Evaluate This Tool in Pediatric Liver Transplantation,” Transplantation 100, no. 4 (2016): 801–807.
O. Abrahim, A. Premkumar, B. Kubi, et al., “Does Failure to Rescue Drive Race/Ethnicity‐Based Disparities in Survival After Heart Transplantation?,” Annals of Surgery 279 (2023): 361–365.
J. H. Silber, S. V. Williams, H. Krakauer, and J. S. Schwartz, “Hospital and Patient Characteristics Associated With Death After Surgery. A Study of Adverse Occurrence and Failure to Rescue,” Medical Care 30, no. 7 (1992): 615–629.
J. I. Portuondo, S. R. Shah, M. V. Raval, et al., “Complications and Failure to Rescue After Inpatient Pediatric Surgery,” Annals of Surgery 276, no. 4 (2022): e239–e246.
N. N. Massarweh, D. A. Anaya, P. Kougias, F. G. Bakaeen, S. S. Awad, and D. H. Berger, “Variation and Impact of Multiple Complications on Failure to Rescue After Inpatient Surgery,” Annals of Surgery 266, no. 1 (2017): 59–65.
S. C. Mehl, J. I. Portuondo, R. W. Pettit, et al., “Association of Prematurity With Complications and Failure to Rescue in Neonatal Surgery,” Journal of Pediatric Surgery 57, no. 10 (2022): 268–276.
S. K. Pasquali, X. He, J. P. Jacobs, M. L. Jacobs, S. M. O'Brien, and J. W. Gaynor, “Evaluation of Failure to Rescue as a Quality Metric in Pediatric Heart Surgery: An Analysis of the STS Congenital Heart Surgery Database,” Annals of Thoracic Surgery 94, no. 2 (2012): 573–580.
L. W. Ma, J. S. Hatchimonji, E. J. Kaufman, C. E. Sharoky, B. P. Smith, and D. N. Holena, “Failure to Rescue as a Center‐Level Metric in Pediatric Trauma,” Surgery 165, no. 6 (2019): 1116–1121.
E. H. Rosenfeld, W. Zhang, B. Johnson, S. R. Shah, A. M. Vogel, and B. Naik‐Mathuria, “The Value of Failure to Rescue in Determining Hospital Quality for Pediatric Trauma,” Journal of Trauma and Acute Care Surgery 87, no. 4 (2019): 794–799.
H. Bismuth, “Surgical Anatomy and Anatomical Surgery of the Liver,” World Journal of Surgery 6, no. 1 (1982): 3–9.
N. A. Goldsmith and R. T. Woodburne, “The Surgical Anatomy Pertaining to Liver Resection,” Surgery, Gynecology & Obstetrics 105, no. 3 (1957): 310–318.
C. de Magnee, L. Brunee, R. Tambucci, et al., “Is ABO‐Incompatible Living Donor Liver Transplantation Really a Good Alternative for Pediatric Recipients?,” Children (Basel) 8, no. 7 (2021): 600–614.
V. Evrard, J. B. Otte, E. Sokal, et al., “Impact of Surgical and Immunological Parameters in Pediatric Liver Transplantation: A Multivariate Analysis in 500 Consecutive Recipients of Primary Grafts,” Annals of Surgery 239, no. 2 (2004): 272–280.
A. A. Darwish, C. Bourdeaux, H. A. Kader, et al., “Pediatric Liver Transplantation Using Left Hepatic Segments From Living Related Donors: Surgical Experience in 100 Recipients at Saint‐Luc University Clinics,” Pediatric Transplantation 10, no. 3 (2006): 345–353.
A. Channaoui, R. Tambucci, A. Pire, et al., “Management and Outcome of Hepatic Artery Thrombosis After Pediatric Liver Transplantation,” Pediatric Transplantation 25, no. 5 (2021): e13938.
R. Tambucci, E. Bonaccorsi‐Riani, and R. Reding, “Living Donor Liver Transplantation in Children,” in Pediatric Liver Transplantation: A Clinical Guide, eds. N. Hadzic, U. Baumann, and V. McLin (Philadelphia: Elsevier, 2021), 63–69.
A. Pire, R. Tambucci, C. De Magnee, et al., “Living Donor Liver Transplantation for Hepatic Malignancies in Children,” Pediatric Transplantation 25, no. 7 (2021): e14047.
C. de Magnee, C. Bourdeaux, F. De Dobbeleer, et al., “Impact of Pre‐Transplant Liver Hemodynamics and Portal Reconstruction Techniques on Post‐Transplant Portal Vein Complications in Pediatric Liver Transplantation: A Retrospective Analysis in 197 Recipients,” Annals of Surgery 254, no. 1 (2011): 55–61.
L. F. Pacheco‐Moreira, M. Enne, E. Balbi, et al., “Selection of Donors for Living Donor Liver Transplantation in a Single Center of a Developing Country: Lessons Learned From the First 100 Cases,” Pediatric Transplantation 10, no. 3 (2006): 311–315.
R. Tambucci, C. de Magnee, M. Szabo, et al., “Sequential Treatment of Biliary Atresia With Kasai Hepatoportoenterostomy and Liver Transplantation: Benefits, Risks, and Outcome in 393 Children,” Frontiers in Pediatrics 9 (2021): 697581.
J. de Ville de Goyet, Y. Struye de Swielande, R. Reding, E. M. Sokal, and J. B. Otte, “Delayed Primary Closure of the Abdominal Wall After Cadaveric and Living Related Donor Liver Graft Transplantation in Children: A Safe and Useful Technique,” Transplant International 11, no. 2 (1998): 117–122.
R. Reding, J. Gras, E. Sokal, J. B. Otte, and H. F. Davies, “Steroid‐Free Liver Transplantation in Children,” Lancet 362, no. 9401 (2003): 2068–2070.
J. M. Gras, S. Gerkens, C. Beguin, et al., “Steroid‐Free, Tacrolimus‐Basiliximab Immunosuppression in Pediatric Liver Transplantation: Clinical and Pharmacoeconomic Study in 50 Children,” Liver Transplantation 14, no. 4 (2008): 469–477.
D. Kelly, P. Jara, B. Rodeck, et al., “Tacrolimus and Steroids Versus Ciclosporin Microemulsion, Steroids, and Azathioprine in Children Undergoing Liver Transplantation: Randomised European Multicentre Trial,” Lancet 364, no. 9439 (2004): 1054–1061.
E. Granot, R. Loewenthal, E. Jakobovich, E. Gazit, E. Sokal, and R. Reding, “Living Related Liver Transplant Following Bone Marrow Transplantation From Same Donor: Long‐Term Survival Without Immunosuppression,” Pediatric Transplantation 16, no. 1 (2012): E1–E4.
A. J. Demetris, K. P. Batts, A. P. Dhillon, et al., “Banff Schema for Grading Liver Allograft Rejection: An International Consensus Document,” Hepatology 25, no. 3 (1997): 658–663.
A. Demetris, D. Adams, C. Bellamy, et al., “Update of the International Banff Schema for Liver Allograft Rejection: Working Recommendations for the Histopathologic Staging and Reporting of Chronic Rejection,” An International Panel. Hepatology 31, no. 3 (2000): 792–799.
D. Dindo, N. Demartines, and P. A. Clavien, “Classification of Surgical Complications: A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey,” Annals of Surgery 240, no. 2 (2004): 205–213.
Y. G. Lu, Z. Y. Pan, S. Zhang, et al., “Living Donor Liver Transplantation in Children: Perioperative Risk Factors and a Nomogram for Prediction of Survival,” Transplantation 104, no. 8 (2020): 1619–1626.
J. S. Neto, E. A. Fonseca, R. Vincenzi, et al., “Technical Choices in Pediatric Living Donor Liver Transplantation: The Path to Reduce Vascular Complications and Improve Survival,” Liver Transplantation 26, no. 12 (2020): 1644–1651.
M. Kasahara, S. Sakamoto, and A. Fukuda, “Pediatric Living‐Donor Liver Transplantation,” Seminars in Pediatric Surgery 26, no. 4 (2017): 224–232.
M. Ueda, F. Oike, Y. Ogura, et al., “Long‐Term Outcomes of 600 Living Donor Liver Transplants for Pediatric Patients at a Single Center,” Liver Transplantation 12, no. 9 (2006): 1326–1336.
N. H. Ebel, E. K. Hsu, A. A. S. Dick, M. L. Shaffer, K. Carlin, and S. P. Horslen, “Decreased Incidence of Hepatic Artery Thrombosis in Pediatric Liver Transplantation Using Technical Variant Grafts: Report of the Society of Pediatric Liver Transplantation Experience,” Journal of Pediatrics 226, no. 195–201 (2020): e191.
A. Badawy, S. M. Brunner, B. Knoppke, et al., “Predictors of Portal Vein Complications After Pediatric Liver Transplantation: A German Center Experience,” Pediatric Transplantation 26, no. 5 (2022): e14298.
Y. Sanada, T. Katano, Y. Hirata, et al., “Biliary Complications Following Pediatric Living Donor Liver Transplantation: Risk Factors, Treatments, and Prognosis,” Transplantation 103, no. 9 (2019): 1863–1870.
C. de Magnee, F. Veyckemans, and T. Pirotte, “Liver and Systemic Hemodynamics in Children With Cirrhosis: Impact on the Surgical Management in Pediatric Living Donor Liver Transplantation,” Liver Transplantation 23, no. 11 (2017): 1440–1450.
T. Darius, J. Rivera, F. Fusaro, et al., “Risk Factors and Surgical Management of Anastomotic Biliary Complications After Pediatric Liver Transplantation,” Liver Transplantation 20, no. 8 (2014): 893–903.