• Michael Gurevich, Vanessa Guy-Viterbo, Magdalena Janssen, Xavier Stephenne, Françoise Smets, Etienne Sokal, Chantal Lefebvre, Jean-Luc Balligand, Thierry Pirotte, Francis Veyckemans, Philippe Clapuyt, Renaud Menten, Dana Dumitriu, Etienne Danse, Laurence Annet, Stephan Clement de Clety, Thierry Detaille, Dominique Latinne, Christine Sempoux, Pierre-François Laterre, Catherine de Magnée, Jan Lerut, and Raymond Reding.
• *Pediatric Liver and Liver Transplantation Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium †Internal Medicine Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium ‡Anesthesiology Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium §Pediatric Radiology Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium ¶Adult Radiology Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium ||Pediatric Intensive Care Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium **Clinical Transplant Immunology Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium ††Pathology Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium ‡‡Abdominal Liver Transplant Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium §§Adult Intensive Care Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
• Ann. Surg. 2015 Dec 1;262(6):1141-9.

ObjectivesTo evaluate the outcome of pediatric living donor liver transplantation (LDLT) regarding portal vein (PV) reconstruction, ABO compatibility, and impact of maternal donation on graft acceptance.BackgroundLDLT and ABO-mismatched transplantation constitute feasible options to alleviate organ shortage in children. Vascular complications of portal hypoplasia in biliary atresia (BA) and acute rejection (AR) are still major concerns in this field.MethodsData from 250 pediatric LDLT recipients, performed at Cliniques Universitaires Saint-Luc between July 1993 and June 2012, were collected retrospectively. Results were analyzed according to ABO matching and PV complications. Uni- and multivariate analyses were performed to study the impact of immunosuppression, sex matching, and maternal donation on AR rate.ResultsOverall, the 10-year patient survival rate was 93.2%. Neither patient or graft loss nor vascular rejection, nor hemolysis, was encountered in the ABO nonidentical patients (n = 58), provided pretransplant levels of relevant isoagglutinins were below 1/16. In BA recipients, the rate of PV complications was lower after portoplasty (4.6%) than after truncal PV anastomosis (9.8%) and to jump graft interposition (26.9%; P = 0.027). In parental donation, maternal grafts were associated with higher 1-year AR-free survival (55.2%) than paternal grafts (39.8%; P = 0.041), but only in BA patients.ConclusionsLDLT, including ABO-mismatched transplantation, constitutes a safe and efficient therapy for liver failure in children. In BA patients with PV hypoplasia, portoplasty seems to constitute the best technique for PV reconstruction. Maternal donation might be a protective factor for AR.

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