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6. Clinical family pre-transplant interviews: an efficient way to predict psychosocial difficulties after paediatric liver transplantation with a living donor

Author

UCL - SSS/IREC/PEDI - Pôle de Pédiatrie, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, UCL - SSS/IRSS - Institut de recherche santé et société, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de psychiatrie infanto-juvénile, Rougier,Laure, Aujoulat, Isabelle, De Magnee, Catherine, de meester, Vanessa, Janssen, Magdalena, Pire, Aurore, Scheers, Isabelle, Smets, Françoise, Sokal, Etienne, Stéphenne, Xavier, Tambucci, Roberto, Wintgens, Anne, Reding, Raymond, 26th Annual Meeting of the Belgian Transplantation Society, UCL - SSS/IREC/PEDI - Pôle de Pédiatrie, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, UCL - SSS/IRSS - Institut de recherche santé et société, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de psychiatrie infanto-juvénile, Rougier,Laure, Aujoulat, Isabelle, De Magnee, Catherine, de meester, Vanessa, Janssen, Magdalena, Pire, Aurore, Scheers, Isabelle, Smets, Françoise, Sokal, Etienne, Stéphenne, Xavier, Tambucci, Roberto, Wintgens, Anne, Reding, Raymond, and 26th Annual Meeting of the Belgian Transplantation Society

Abstract

From 1984 to 2018, 1120 paediatric liver transplantations (PLTs) have been performed, of which 438 with living donor (LD). We systematically conduct pre-transplant psychological assessments,which consist at least in a clinical family interview. We hypothesize that such approach may predict psychosocial difficulties for families in the course of the transplant. Methods: Content analysis of 130 pre-transplant reports written between 1/07/2014 and 31/10/2018, personal prospective notes by the psychologist and interviews of other members of the team. The results are based on the systematic analysis of the first 54 situations of living donor PLTs. After transplantation, 39/54 (72%) families did not experience particular psychosocial difficulties whereas 15 (28%) needed psychosocial support. Only 9 of these 15 situations had been identified as being at risk, through our clinical interview before trans-plantation. The red flags identified by the psychologist in relation to these families were in ade-quacy with the type of difficulties experienced after transplantation. Looking at the remaining 6 (11%) whose psychosocial risk had not been identified, we analysed whether it would have been possible to predict post-operative psychosocial adjustments. In 3 situations, medical complications were the main determinant of the non-predictable psychosocial difficulties. In 3 situations however, the risk might have been predicted if we had investigated morein-depth the larger environment of the family. Our results suggest that a systemic approach with at least a clinical family interview predicts in 89% psychosocial risks and points of attention for living donor candidates and their family before PLT.

Published
2019

7. Psychosocial assessment of complex multicultural situations in paediatric liver transplantation with living donors: the benefits of a systemic approach

Author

UCL - SSS/IREC/PEDI - Pôle de Pédiatrie, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, UCL - SSS/IRSS - Institut de recherche santé et société, UCL - (SLuc) Service de psychiatrie infanto-juvénile, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Rougier, Laure, Reding, Raymond, De Magnee, Catherine, Janssen, Magdalena, Pire, Aurore, Sokal, Etienne, Smets, Françoise, Scheers, Isabelle, Stéphenne, Xavier, Tambucci, Roberto, Aujoulat, Isabelle, 26th Annual Meeting of the Belgian Transplantation Society, UCL - SSS/IREC/PEDI - Pôle de Pédiatrie, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, UCL - SSS/IRSS - Institut de recherche santé et société, UCL - (SLuc) Service de psychiatrie infanto-juvénile, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Rougier, Laure, Reding, Raymond, De Magnee, Catherine, Janssen, Magdalena, Pire, Aurore, Sokal, Etienne, Smets, Françoise, Scheers, Isabelle, Stéphenne, Xavier, Tambucci, Roberto, Aujoulat, Isabelle, and 26th Annual Meeting of the Belgian Transplantation Society

Abstract

From 1984 to 2018, 1115 paediatric liver transplantations have been performed, of which 433 with living donors. With patients coming from 13 different countries, our centre has a strong international dimension. The Live Organ Donor Consensus Group has formulated a statement according to which “a psychological evaluation is necessary for each potential donor”[i]. In our centre, we systematically conduct pre-transplant psychological assessments, which consist in a clinical family interview. The complexity of the family situations having increased over the last few years, we aimed to address the relevance and efficiency of our pre-transplant interviews. Methods: Content analysis of 130 pre-transplant reports written between 1/07/2014 and 31/10/2018 were reviewed, as well as personal prospective notes by the psychologist, in the follow-up of the families after transplantation during the same period, with a systemic attention to the transplanted child’s family. Results: Our reflective work sheds light on the evolution of our practice of pre-transplant interviews, which has evolved from family interviews focused on the living donor, to interviews that consider all the aspects of the family dynamics, including the cultural dimension. The analysis of our prospective notes revealed that the potential risks are not only related to personal characteristics of the living donor candidate, but can also be connected with his/her environment. Moreover, the psychosocial risk does not concern the donor candidate alone, but may well extend to other significant family members, including those who remained in the country of origin. We are receiving families who have experienced unique life circumstances, such as histories of intra-familial tensions or violence, death of previous children, experiences of war or jail … Family dynamics are affected differently by such circumstances, with psychosocial risks at various level and for different family members as a consequence. As a result of e

Published
2019

8. How to predict psychosocial difficulties after paediatric liver transplantation with a living donor: the efficieny of clinical pre-transplant interviews

Author

UCL - SSS/IREC/PEDI - Pôle de Pédiatrie, UCL - SSS/IRSS - Institut de recherche santé et société, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de psychiatrie infanto-juvénile, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, Rougier, Laure, Aujoulat, Isabelle, De Magnee, Catherine, de Meester, Vanessa, Janssen, Magdalena, Pire, Aurore, Sokal, Etienne, Smets, Françoise, Scheers, Isabelle, Stéphenne, Xavier, Tambucci, Roberto, Wintgens, Anne, Reding, Raymond, 5th ELPAT Congress, UCL - SSS/IREC/PEDI - Pôle de Pédiatrie, UCL - SSS/IRSS - Institut de recherche santé et société, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de psychiatrie infanto-juvénile, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, Rougier, Laure, Aujoulat, Isabelle, De Magnee, Catherine, de Meester, Vanessa, Janssen, Magdalena, Pire, Aurore, Sokal, Etienne, Smets, Françoise, Scheers, Isabelle, Stéphenne, Xavier, Tambucci, Roberto, Wintgens, Anne, Reding, Raymond, and 5th ELPAT Congress

Abstract

How to predict psychosocial difficulties after paediatric liver transplantation with a living donor: the efficieny of clinical pre-transplant interviews

Published
2019

9. The benefit of a systemic approach in psychosocial assessment of complex multicultural situations in paediatric liver transplantation wiht living donor

Author

UCL - SSS/IREC/PEDI - Pôle de Pédiatrie, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, UCL - SSS/IRSS - Institut de recherche santé et société, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de psychiatrie infanto-juvénile, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, Rougier, Laure, Reding, Raymond, De Magnee, Catherine, de Meester, Vanessa, Janssen, Magdalena, Pire, Aurore, Sokal, Etienne, Smets, Françoise, Scheers, Isabelle, Stéphenne, Xavier, Tambucci, Roberto, Wintgens, Anne, Aujoulat, Isabelle, 5th ELPAT Congress, UCL - SSS/IREC/PEDI - Pôle de Pédiatrie, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, UCL - SSS/IRSS - Institut de recherche santé et société, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de psychiatrie infanto-juvénile, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, Rougier, Laure, Reding, Raymond, De Magnee, Catherine, de Meester, Vanessa, Janssen, Magdalena, Pire, Aurore, Sokal, Etienne, Smets, Françoise, Scheers, Isabelle, Stéphenne, Xavier, Tambucci, Roberto, Wintgens, Anne, Aujoulat, Isabelle, and 5th ELPAT Congress

Abstract

The benefit of a systemic approach in psychosocial assessment of complex multicultural situations in paediatric liver transplantation wiht living donor

Published
2019

10. The protection of the family members of the testator in Poland in historical-legal context

Author

Janssen, Magdalena

Subjects
spadkodawca, dziedziczenie, zachowek, legitimate portion, testator, heir, spadkobierca, succession
Abstract

Spór pomiędzy prawem spadkodawcy do swobodnego dysponowania mieniem a jego powinnością wobec najbliższych wzbudza wiele emocji oraz jest źródłem problemów legislacyjnych. Jest to związane z tym, iż na powstanie roszczenia o zachowek ma wpływ wiele czynników. Ustawodawca, regulując powyższe kwestie, nieustannie obraca się w kręgu sprzecznych interesów uprawnionego do zachowku i zobowiązanego do jego zapłaty. Nie ma przy tym jedynego właściwego wzorca, którym mógłby się kierować. Podjęcie badań nad procesem kształtowania się swobody testowania i związanych z nim ograniczeń ma istotny wpływ na zrozumienie istoty sprawy, a co za tym idzie – inicjowanie właściwych działań prawodawczych w tym obszarze. Nie bez podstawy bowiem w doktrynie podnosi się, że prawo spadkowe jest w Polsce zaniedbane, a historycznoprawna analiza w tym zakresie unikatowa. Osadzenie przeprowadzonych badań w kontekście społeczno-kulturowym pozwoliło na wskazanie silnych zależności pomiędzy ewolucją swobody testowania i jej ograniczeniami a procesami przemian społecznych, znajdującymi swe odbicie w strukturze i ekonomicznym modelu funkcjonowania rodziny. W niniejszej pracy sięgnięto do wzorcowych regulacji prawa rzymskiego, zwyczajów prawnych okresu średniowiecza, przeanalizowano genezę pierwszych europejskich kodyfikacji oraz proces unifikacji i kodyfikacji prawa polskiego w zakresie podjętej problematyki. The dispute between testamentary freedom and the duty of a testator to take care of his family provokes a lot of emotions and causes legislation difficulties. It is connected to the fact, that a lot of factors may be relevant to the inception claims to the legitimate portion. The legislator, governing this issue, must constantly balance contrary interests between the ones entitled to the legitimate portion and the ones indebted to pay for it. There is also no confirmed model which can be used by the legislator. The undertaken studies of the evolution of testamentary freedom and its restrictions have got a significant impact on the understanding of this law institution and in consequence – can help to stimulate an appropriate law activities in this area. Not without reason the doctrine points to the fact that the succession law in Poland has been neglected and also historical-legal analysis of the issue is rare. The research is placed in a social and cultural context, which allowed us to indicate links between the evolution of testamentary freedom, its restrictions and the changing society which has had an effect on the structure and the economic model of the family functioning. This paper presents the regulations in Roman law, the legal practices of the Middle Ages, the genesis of the first European codifications and the process of the unification and the codification of the Polish law in this problematic area.

Published
2017

12. Living Donor Liver Transplantation in Children: Surgical and Immunological Results in 250 Recipients at Université Catholique de Louvain.

Author

UCL - (SLuc) Service de radiologie, UCL - (SLuc) Service de soins intensifs, UCL - (SLuc) Service d'anatomie pathologique, UCL - SSS/IREC/IMAG - Pôle d'imagerie médicale, UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - SSS/IREC/PEDI - Pôle de Pédiatrie, UCL - (SLuc) Service de pédiatrie générale, UCL - (SLuc) Service de médecine interne générale, UCL - SSS/IREC/FATH - Pôle de Pharmacologie et thérapeutique, UCL - SSS/IONS - Institute of NeuroScience, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, UCL - (SLuc) Service d'anesthésiologie, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de biologie hématologique, Gurevich , Michael, Guy-Viterbo, Vanessa, Janssen, Magdalena, Stéphenne, Xavier, Smets, Françoise, Sokal, Etienne, Lefebvre, Chantal, Balligand, Jean-Luc, Pirotte, Thierry, Veyckemans, Francis, Clapuyt, Philippe, Menten, Renaud, Dumitriu, Dana Loana, Danse, Etienne, Annet, Laurence, Clement de Clety, Stephan, Detaille , Thierry, Latinne, Dominique, Sempoux, Christine, Laterre, Pierre-François, De Magnée, Catherine, Lerut, Jan, Reding, Raymond, UCL - (SLuc) Service de radiologie, UCL - (SLuc) Service de soins intensifs, UCL - (SLuc) Service d'anatomie pathologique, UCL - SSS/IREC/IMAG - Pôle d'imagerie médicale, UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - SSS/IREC/PEDI - Pôle de Pédiatrie, UCL - (SLuc) Service de pédiatrie générale, UCL - (SLuc) Service de médecine interne générale, UCL - SSS/IREC/FATH - Pôle de Pharmacologie et thérapeutique, UCL - SSS/IONS - Institute of NeuroScience, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, UCL - (SLuc) Service d'anesthésiologie, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de biologie hématologique, Gurevich , Michael, Guy-Viterbo, Vanessa, Janssen, Magdalena, Stéphenne, Xavier, Smets, Françoise, Sokal, Etienne, Lefebvre, Chantal, Balligand, Jean-Luc, Pirotte, Thierry, Veyckemans, Francis, Clapuyt, Philippe, Menten, Renaud, Dumitriu, Dana Loana, Danse, Etienne, Annet, Laurence, Clement de Clety, Stephan, Detaille , Thierry, Latinne, Dominique, Sempoux, Christine, Laterre, Pierre-François, De Magnée, Catherine, Lerut, Jan, and Reding, Raymond

Abstract

OBJECTIVES: To 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. BACKGROUND: LDLT 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. METHODS: Data 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. RESULTS: Overall, 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. CONCLUSIONS: LDLT, 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.

Published
2015

13. Better maternal liver graft acceptance in pediatric recipients with biliary atresia: a univariate/multivariate study in 207 children

Author

UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de biochimie médicale, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Guy-Viterbo, Vanessa, Gurevich, Michael, Janssen, Magdalena, De Magnee, Catherine, Reding, Raymond, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de biochimie médicale, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Guy-Viterbo, Vanessa, Gurevich, Michael, Janssen, Magdalena, De Magnee, Catherine, and Reding, Raymond

Published
2015

14. Liver transplantation (LT) for hepatocellular carcinoma in childhood and adolescence: the Brussels experience

Author

UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - SSS/IREC/PEDI - Pôle de Pédiatrie, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, UCL - (SLuc) Service d'hématologie et d'oncologie pédiatrique, Bourdeaux, Christophe, Hollanders de Ouderaen, Sacha, Stéphenne, Xavier, Smets, Françoise, Scheers, Isabelle, Janssen, Magdalena, De Magnee, Catherine, Sokal, Etienne, Brichard, Bénédicte, Otte, Jean-Bernard, Reding, Raymond, 47th Congress of the International Society of Paediatric Oncology (SIOP), UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - SSS/IREC/PEDI - Pôle de Pédiatrie, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, UCL - (SLuc) Service d'hématologie et d'oncologie pédiatrique, Bourdeaux, Christophe, Hollanders de Ouderaen, Sacha, Stéphenne, Xavier, Smets, Françoise, Scheers, Isabelle, Janssen, Magdalena, De Magnee, Catherine, Sokal, Etienne, Brichard, Bénédicte, Otte, Jean-Bernard, Reding, Raymond, and 47th Congress of the International Society of Paediatric Oncology (SIOP)

Published
2015

15. Living Donor Liver Transplantation in Children

Author

Gurevich, Michael, primary, Guy-Viterbo, Vanessa, additional, Janssen, Magdalena, additional, Stephenne, Xavier, additional, Smets, Françoise, additional, Sokal, Etienne, additional, Lefebvre, Chantal, additional, Balligand, Jean-Luc, additional, Pirotte, Thierry, additional, Veyckemans, Francis, additional, Clapuyt, Philippe, additional, Menten, Renaud, additional, Dumitriu, Dana, additional, Danse, Etienne, additional, Annet, Laurence, additional, Clety, Stephan Clement de, additional, Detaille, Thierry, additional, Latinne, Dominique, additional, Sempoux, Christine, additional, Laterre, Pierre-François, additional, de Magnée, Catherine, additional, Lerut, Jan, additional, and Reding, Raymond, additional

Published
2015
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16. Internalizing motivation to self-care: a multifaceted challenge for young liver transplant recipients.

Author

UCL - SSS/IRSS - Institut de recherche santé et société, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, UCL - SSS/IREC/PEDI - Pôle de Pédiatrie, Aujoulat, Isabelle, Janssen, Magdalena, Libion, Marie-France, Charles, Anne-Sophie, Struyf, Catherine, Smets, Françoise, Stéphenne, Xavier, De Magnee, Catherine, Sokal, Etienne, Lerut, Jan, Ciccarelli, Olga, Reding, Raymond, UCL - SSS/IRSS - Institut de recherche santé et société, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, UCL - SSS/IREC/PEDI - Pôle de Pédiatrie, Aujoulat, Isabelle, Janssen, Magdalena, Libion, Marie-France, Charles, Anne-Sophie, Struyf, Catherine, Smets, Françoise, Stéphenne, Xavier, De Magnee, Catherine, Sokal, Etienne, Lerut, Jan, Ciccarelli, Olga, and Reding, Raymond

Abstract

The transition from parent-controlled care to self-managed care represents an important challenge for adolescents with chronic conditions. We sought to gain a deeper understanding of the factors influencing the internalization of motivation to self-care in adolescent liver transplant recipients. We conducted a qualitative study using in-depth interviews with 18 young patients. We triangulated the data collected from the patients with data from parents and health care providers, and used an inductive approach to analyze the data. Our results illustrate three interrelated challenges that impact on young patients' motivation to self-care: (a) the cognitive challenge of fully understanding one's condition and personal health risks; (b) the behavioral challenge of developing independence regarding self-management issues; and (c) the psychological challenge of building a sense of self-ownership and purpose. The latter involves overcoming the trauma of survival and coming to terms with feelings of obligation, two challenges inherent to transplantation that warrant further investigation.

Published
2014

17. Risk factors and surgical management of anastomotic biliary complications after pediatric liver transplantation.

Author

UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - SSS/IREC/IMAG - Pôle d'imagerie médicale, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de radiologie, Darius, Tom, Rivera, Jairo, Fusaro, Fabio, Lai, Quirino, De Magnee, Catherine, Bourdeaux, Christophe, Janssen, Magdalena, Clapuyt, Philippe, Reding, Raymond, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - SSS/IREC/IMAG - Pôle d'imagerie médicale, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de radiologie, Darius, Tom, Rivera, Jairo, Fusaro, Fabio, Lai, Quirino, De Magnee, Catherine, Bourdeaux, Christophe, Janssen, Magdalena, Clapuyt, Philippe, and Reding, Raymond

Abstract

Biliary complications (BCs) still remain the Achilles heel of liver transplantation (LT) with an overall incidence of 10% to 35% in pediatric series. We hypothesized that (1) the use of alternative techniques (reduced size, split, and living donor grafts) in pediatric LT may contribute to an increased incidence of BCs, and (2) surgery as a first treatment option for anastomotic BCs could allow a definitive cure for the majority of these patients. Four hundred twenty-nine primary pediatric LT procedures, including 88, 91, 47, and 203 whole, reduced size, split, and living donor grafts, respectively, that were performed between July 1993 and November 2010 were retrospectively reviewed. Demographic and surgical variables were analyzed, and their respective impact on BCs was studied with univariate and multivariate analyses. The modalities of BC management were also reviewed. The 1- and 5-year patient survival rates were 94% and 90%, 89% and 85%, 94% and 89%, and 98% and 94% for whole, reduced size, split, and living donor liver grafts, respectively. The overall incidence of BCs was 23% (n = 98). Sixty were anastomotic complications [47 strictures (78%) and 13 fistulas (22%)]. The graft type was not found to be an independent risk factor for the development of BCs. According to a multivariate analysis, only hepatic artery thrombosis and acute rejection increased the risk of anastomotic BCs (P < 0.001 and P = 0.003, respectively). Anastomotic BCs were managed primarily with surgical repair in 59 of 60 cases with a primary patency rate of 80% (n = 47). These results suggest that (1) most of the BCs were anastomotic complications not influenced by the type of graft, and (2) the surgical management of anastomotic BCs may constitute the first and best therapeutic option. Liver Transpl 20:893-903, 2014. © 2014 AASLD.

Published
2014

18. Non-adherence in adolescent transplant recipients the role of uncertainty in health care providers

Author

UCL - SSS/IRSS - Institut de recherche santé et société, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Aujoulat, Isabelle, Deccache, Alain, Charles, Anne Sophie, Janssen, Magdalena, Struyf, Catherine, Pélicand, Julie, Ciccarelli, Olga, Dobbels, Fabienne, Reding, Raymond, UCL - SSS/IRSS - Institut de recherche santé et société, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Aujoulat, Isabelle, Deccache, Alain, Charles, Anne Sophie, Janssen, Magdalena, Struyf, Catherine, Pélicand, Julie, Ciccarelli, Olga, Dobbels, Fabienne, and Reding, Raymond

Abstract

To optimize self-management and adherence in adolescent patients, HCPs need to discuss not only medical and treatment-related issues, but also general health and psychosocial concerns. Our study aimed to explore how the members of the paediatric team in our programme understand NA in adolescents, and how they define their own role regarding self-management education. We used a sequential mixed methods design and conducted a qualitative observational and in-depth interview study (n=22) and a quantitative descriptive study through self-administered questionnaires (n=31). Our results show a discrepancy between the HCPs’ understanding of the complex psychosocial factors impacting on long-term adherence, and their current limited practice of patient education. A number of uncertainties were found to explain the HCPs’ perceived difficulty to engage in comprehensive patient education activities: uncertainty regarding (i) the health status of transplant recipients; (ii) a shared operational definition of adherence and the cause of organ rejection in some cases; (iii) the extent to which adherence is a shared responsibility which involves the HCPs as patient educators; (iv) the long-term impact of a LRD. To avoid the risk of conveying incongruent messages, multidisciplinary health care teams need to explicitly acknowledge and discuss the various areas of uncertainty, some of which are inherent to transplantation.

Published
2011

19. 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

Author

UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de radiologie, UCL - SSS/IREC/IMAG - Pôle d'imagerie médicale, UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Centre du cancer, UCL - (SLuc) Centre de malformations vasculaires congénitales, UCL - (SLuc) Centre de pathologie anorectale de l'enfant, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, De Magnee, Catherine, Bourdeaux, Christophe, De Dobbeleer, Florence, Janssen, Magdalena, Menten, Renaud, Clapuyt, Philippe, Reding, Raymond, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de radiologie, UCL - SSS/IREC/IMAG - Pôle d'imagerie médicale, UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Centre du cancer, UCL - (SLuc) Centre de malformations vasculaires congénitales, UCL - (SLuc) Centre de pathologie anorectale de l'enfant, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, De Magnee, Catherine, Bourdeaux, Christophe, De Dobbeleer, Florence, Janssen, Magdalena, Menten, Renaud, Clapuyt, Philippe, and Reding, Raymond

Abstract

Portal vein (PV) complications are the most frequent vascular complications in pediatric liver transplant (LT). We hypothesized that pre-LT liver hemodynamic parameters and PV reconstruction technique could predict the risk of PV complications post-LT.

Published
2011

20. Impact of Pre-Transplant Liver Hemodynamics and Portal Reconstruction Technique on Post-Transplant Portal Vein Complications in Pediatric Liver Transplantation

Author

UCL - Cliniques universitaires Saint-Luc, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, De Magnee, Catherine, Menten, Renaud, Clapuyt, Philippe, Reding, Raymond, Bourdeaux, Christophe, De Dobbeleer, Florence, Janssen, Magdalena, 10th American Transplant Congress, UCL - Cliniques universitaires Saint-Luc, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, De Magnee, Catherine, Menten, Renaud, Clapuyt, Philippe, Reding, Raymond, Bourdeaux, Christophe, De Dobbeleer, Florence, Janssen, Magdalena, and 10th American Transplant Congress

Published
2010

21. Uncertainty in healthcare providers may impact on long-term follow-up of adolescent transplant recipients

Author

UCL - Cliniques universitaires Saint-Luc, UCL - SSS/IRSS - Institut de recherche santé et société, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, Aujoulat, Isabelle, Reding, Raymond, Deccache, Alain, Charles, Anne Sophie, Janssen, Magdalena, Struyf, Catherine, Pélicand, Julie, 10th American Transplant Congress, UCL - Cliniques universitaires Saint-Luc, UCL - SSS/IRSS - Institut de recherche santé et société, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, Aujoulat, Isabelle, Reding, Raymond, Deccache, Alain, Charles, Anne Sophie, Janssen, Magdalena, Struyf, Catherine, Pélicand, Julie, and 10th American Transplant Congress

Published
2010

22. Pre-Graft Liver Hemodynamics and Portal Reconstruction Technique Impact on Post-Graft Portal Vein Complications in Pediatric Liver Transplantation

Author

UCL - Cliniques universitaires Saint-Luc, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, De Magnee, Catherine, Menten, Renaud, Clapuyt, Philippe, Reding, Raymond, Bourdeaux, Christophe, De Dobbeleer, Florence, Janssen, Magdalena, UCL - Cliniques universitaires Saint-Luc, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, De Magnee, Catherine, Menten, Renaud, Clapuyt, Philippe, Reding, Raymond, Bourdeaux, Christophe, De Dobbeleer, Florence, and Janssen, Magdalena

Published
2010

23. Long-term follow-up of pediatric liver transplant recipients : Providers’ perspectives regarding their educational role

Author

UCL - SSS/IRSS - Institut de recherche santé et société, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Aujoulat, Isabelle, Charles, Anne Sophie, Janssen, Magdalena, Struyf, Catherine, Pélicand, Julie, Deccache, Alain, Reding, Raymond, ELPAT conference 2010, UCL - SSS/IRSS - Institut de recherche santé et société, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Aujoulat, Isabelle, Charles, Anne Sophie, Janssen, Magdalena, Struyf, Catherine, Pélicand, Julie, Deccache, Alain, Reding, Raymond, and ELPAT conference 2010

Published
2010

24. Steroid-Free Immunosuppression Promotes Prope or Operational Tolerance after Pediatric Liver Transplantation.

Author

UCL - Cliniques universitaires Saint-Luc, UCL - MD/CHIR - Département de chirurgie, Reding, Raymond, De Magnee, Catherine, Pire, Aurore, Janssen, Magdalena, Brunati, Andrea, Bourdeaux, Christophe, UCL - Cliniques universitaires Saint-Luc, UCL - MD/CHIR - Département de chirurgie, Reding, Raymond, De Magnee, Catherine, Pire, Aurore, Janssen, Magdalena, Brunati, Andrea, and Bourdeaux, Christophe

Published
2009

25. Liver retransplantation in children. A 21-year single-center experience*

Author

UCL - MD/CHIR - Département de chirurgie, UCL - MD/GYPE - Département de gynécologie, d'obstétrique et de pédiatrie, Bourdeaux, Christophe, Brunati, Andrea, Janssen, Magdalena, de Magnée, Catherine, Otte, Jean-Bernard, Sokal, Etienne, Reding, Raymond, UCL - MD/CHIR - Département de chirurgie, UCL - MD/GYPE - Département de gynécologie, d'obstétrique et de pédiatrie, Bourdeaux, Christophe, Brunati, Andrea, Janssen, Magdalena, de Magnée, Catherine, Otte, Jean-Bernard, Sokal, Etienne, and Reding, Raymond

Abstract

In this study, the epidemiology and outcome of graft loss following primary pediatric liver transplantation (LT) were analysed, with the hypothesis that early retransplantation (reLT) might be associated with lower immunologic risks when compared with late reLT. Between March 1984 and December 2005, 745 liver grafts were transplanted to 638 children at Saint-Luc University Hospital, Brussels. Among them, a total of 90 children (14%) underwent 107 reLT, and were categorized into two groups (early reLT, n = 58; late reLT, n = 32), according to the interval between either transplant procedures (< or >30 days). Ten-year patient survival rate was 85% in recipients with a single LT, vs. 61% in recipients requiring reLT (P < 0.001). Ten-year patient survival rates were 59% and 66% for early and late reLT, respectively (P = 0.423), the corresponding graft survival rates being 51% and 63% (P = 0.231). Along the successive eras, the rate of reLT decreased from 17% to 10%, whereas progressive improvement of outcome post-reLT was observed. No recurrence of chronic rejection (CR) was observed after reLT for CR (0 of 19). Two children developed a positive cross-match at reLT (two of 10, 20%), both retransplanted lately for CR secondary to immunosuppression withdrawal following a post-transplant lymphoproliferative disease. In summary, the results presented could not evidence better results for late reLT when compared with early reLT. The former did not seem to be associated with higher immunologic risk, except for children having withdrawal of immunosuppression following the first graft.

Published
2008

26. Pediatric liver transplantation using left hepatic segments from living related donors: surgical experience in 100 recipients at Saint-Luc University Clinics.

Author

UCL - MD/CHIR - Département de chirurgie, UCL - MD/GYPE - Département de gynécologie, d'obstétrique et de pédiatrie, UCL - (SLuc) Centre du cancer, UCL - (SLuc) Centre de lutte contre la douleur, UCL - (SLuc) Centre de pathologie anorectale de l'enfant, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, UCL - (SLuc) Service d'anesthésiologie, Darwish, Ahmed A, Bourdeaux, Christophe, Kader, Hesham A, Janssen, Magdalena, Sokal, Etienne, Lerut, Jan, Ciccarelli, Olga, Veyckemans, Francis, Otte, Jean-Bernard, de ville de goyet, jean, Reding, Raymond, UCL - MD/CHIR - Département de chirurgie, UCL - MD/GYPE - Département de gynécologie, d'obstétrique et de pédiatrie, UCL - (SLuc) Centre du cancer, UCL - (SLuc) Centre de lutte contre la douleur, UCL - (SLuc) Centre de pathologie anorectale de l'enfant, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, UCL - (SLuc) Service d'anesthésiologie, Darwish, Ahmed A, Bourdeaux, Christophe, Kader, Hesham A, Janssen, Magdalena, Sokal, Etienne, Lerut, Jan, Ciccarelli, Olga, Veyckemans, Francis, Otte, Jean-Bernard, de ville de goyet, jean, and Reding, Raymond

Abstract

Living-related liver transplantation was developed in the context of deceased donor organ shortage, which is particularly acute for pediatric recipients. This retrospective study analyzes the surgical technique and complications in the first 100 pediatric liver transplantation using left segmental liver grafts from living donors, performed at Saint-Luc University Clinics between July 1993 and April 2002. Pre-operative evaluation in donors and recipients, analysis of the surgical technique, and postoperative complications were reviewed. After a median follow-up period of 2526 days, no donor mortality was encountered, with a minimal morbidity and no long-term sequelae. At one and five yr post-transplantation, the actuarial patient survival rates were 94% and 92%, the corresponding figures being 92% and 89% for graft survival. The incidences of portal vein and hepatic artery thromboses, and of biliary complications were 14%, 1%, and 27%, respectively. Living-related liver transplantation in children constitutes an efficient therapy for liver failure to face the increased demand for liver grafts. Donor morbidity was kept to acceptable incidence, and surgical technique in the recipient needs to be tailored to minimize postoperative complications.

Published
2006

27. Safety of living-related liver transplantation for progressive familial intrahepatic cholestasis.

Author

UCL - MD/GYPE - Département de gynécologie, d'obstétrique et de pédiatrie, UCL - MD/CHIR - Département de chirurgie, UCL - (SLuc) Centre de pathologie anorectale de l'enfant, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de pédiatrie générale, Cutillo, Luisa, Najimi, Mustapha, Smets, Françoise, JANSSEN, Magdalena, Reding, Raymond, de Ville de Goyet, Jean, Sokal, Etienne, UCL - MD/GYPE - Département de gynécologie, d'obstétrique et de pédiatrie, UCL - MD/CHIR - Département de chirurgie, UCL - (SLuc) Centre de pathologie anorectale de l'enfant, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de pédiatrie générale, Cutillo, Luisa, Najimi, Mustapha, Smets, Françoise, JANSSEN, Magdalena, Reding, Raymond, de Ville de Goyet, Jean, and Sokal, Etienne

Abstract

Progressive familial intrahepatic cholestasis (PFIC) is a severe cholestatic liver disease of early life often requiring liver transplantation. Organ shortage leads to consider living-related liver transplantation. Because of possible partial metabolic defect in heterozygotes, the use of familial donors might be questionable. We therefore evaluated the safety of this procedure, for both donors and recipients. We compared a series of seven parental-children pairs, having participated in the living related liver transplant program for PFIC between 1994 and 2001, with that of a series of seven parental-children pairs, performed for biliary atresia (BA) during the same period. No primary graft dysfunction was observed. There was no difference in the course of transaminases, gamma-glutamyl transpeptidase and bilirubin levels after transplantation in both donor and recipient series. Thirteen recipients and 14 donors are alive and well 3-10 yr post-surgery. One PFIC recipient died nine months post-orthotopic liver transplantation from sepsis. We conclude that PFIC heterozygote status of the donor does not increase the risk of liver dysfunction in either recipients or donors, with a similar course compared with BA recipients and donors.

Published
2006

28. Liver allograft radiotherapy to treat rejection in children: efficacy in orthotopic liver transplantation and long-term safety.

Author

UCL - MD/GYPE - Département de gynécologie, d'obstétrique et de pédiatrie, UCL - MD/CHIR - Département de chirurgie, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Centre de pathologie anorectale de l'enfant, UCL - (SLuc) Centre de thérapie tissulaire et cellulaire, Stéphenne, Xavier, Najimi, Mustapha, Janssen, Magdalena, Reding, Raymond, de Ville de Goyet, Jean, Sokal, Etienne, UCL - MD/GYPE - Département de gynécologie, d'obstétrique et de pédiatrie, UCL - MD/CHIR - Département de chirurgie, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Centre de pathologie anorectale de l'enfant, UCL - (SLuc) Centre de thérapie tissulaire et cellulaire, Stéphenne, Xavier, Najimi, Mustapha, Janssen, Magdalena, Reding, Raymond, de Ville de Goyet, Jean, and Sokal, Etienne

Abstract

BACKGROUND: We studied, retrospectively, the efficacy to control rejection and long-term safety of liver allograft radiotherapy (RT) performed in 14 children. Long-term safety data were collected with the prospect of possible use of RT in liver cell transplantation (LCT). METHODS: Immune suppression included cyclosporine, azathioprine and prednisone. In case of intractable rejection, low-dose allograft RT was administered daily for 3 days, and short-term efficacy was evaluated by liver enzyme assays and histology. The long-term outcome was compared with that of 122 patients undergone transplantation and who had similar treatment, but no RT. RESULTS: Survival at 15 years was 71.4% vs 69.7% in the comparison group. In the RT group, rejection control was complete in six of 14 children and partial in two, all being alive and well 14-18 years later. Ten of 14 children had follow-up biopsy. Six children had normal histology and four had mild unspecific fibrosis. The long-term follow-up biopsy in the comparison group showed fibrosis in 42 of 85 children. The incidence of complications was similar in both groups. CONCLUSIONS: This series shows that, such a RT regimen appeared to be efficient and safe as a rescue treatment for acute rejection. Provided that further investigations in animal models show a certain benefit of low-dose irradiation around LCT, such a regimen could be proposed in human liver cell transplant programmes.

Published
2005

30. Steroid withdrawal after pediatric liver transplantation: a long-term follow-up study in 109 recipients.

Author

UCL - MD/GYPE - Département de gynécologie, d'obstétrique et de pédiatrie, UCL - MD/CHIR - Département de chirurgie, UCL - (SLuc) Centre du cancer, UCL - (SLuc) Centre de thérapie tissulaire et cellulaire, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Centre de pathologie anorectale de l'enfant, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, Diem, Hanh Vo Thi, Sokal, Etienne, Janssen, Magdalena, Otte, Jean-Bernard, Reding, Raymond, UCL - MD/GYPE - Département de gynécologie, d'obstétrique et de pédiatrie, UCL - MD/CHIR - Département de chirurgie, UCL - (SLuc) Centre du cancer, UCL - (SLuc) Centre de thérapie tissulaire et cellulaire, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Centre de pathologie anorectale de l'enfant, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, Diem, Hanh Vo Thi, Sokal, Etienne, Janssen, Magdalena, Otte, Jean-Bernard, and Reding, Raymond

Abstract

BACKGROUND: Steroids remain an important component of maintenance immunosuppression in liver transplantation, but when administered for a long period they may be associated with multiple severe side effects, particularly growth suppression in children. This study was conducted to clarify the balance of potential benefits and risks of steroid withdrawal (SW) in pediatric liver transplantation. METHODS: Between April 1984 and July 2000, 109 pediatric recipients with SW and at least 12 months of follow-up after SW were retrospectively reviewed and divided into three groups according to the type of anticalcineurin at SW: group I (cyclosporine, n=25), group II (cyclosporine microemulsion, n=25), and group III (tacrolimus, n=59). Steroids were withdrawn after a three-step reduction of steroid dosage (taper down to the substitution dose of 0.25 mg/kg/day, switch to alternate-day therapy, progressive SW). Patients were regularly followed up for clinical and biochemical monitoring. RESULTS: Median follow-up was 8.1 (range, 1.6-16.8) years. After SW, neither chronic rejection nor graft nor patient loss occurred. A trend toward lower anticalcineurin trough levels was observed in all groups. Glomerular filtration rate and fasting cholesterol were significantly better in group III (P<0.05). Median height z-score in all patients was -1.1 SD on alternate-day steroids versus -0.2 SD at the time of SW. Height z-score was slightly better in group III (NS). Early SW within 2 years after transplantation allowed a slightly better gain in growth. CONCLUSIONS: SW in pediatric liver transplantation is safe and may be beneficial to height outcome. Tacrolimus seems to offer several advantages in the long-term outcome.

Published
2003

31. Living-related liver transplantation and vena cava reconstruction after total hepatectomy including the vena cava for hepatoblastoma.

Author

UCL - MD/GYPE - Département de gynécologie, d'obstétrique et de pédiatrie, UCL - MD/RAIM - Département de radiologie et d'imagerie médicale, UCL - MD/CHIR - Département de chirurgie, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de radiologie, UCL - (SLuc) Service d'hématologie et d'oncologie pédiatrique, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, Chardot, Christophe, Saint Martin, Christine, Gilles, André, Brichard, Bénédicte, Janssen, Magdalena, Sokal, Etienne, Clapuyt, Philippe, Lerut, Jan, Reding, Raymond, Otte, Jean-Bernard, UCL - MD/GYPE - Département de gynécologie, d'obstétrique et de pédiatrie, UCL - MD/RAIM - Département de radiologie et d'imagerie médicale, UCL - MD/CHIR - Département de chirurgie, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de radiologie, UCL - (SLuc) Service d'hématologie et d'oncologie pédiatrique, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, Chardot, Christophe, Saint Martin, Christine, Gilles, André, Brichard, Bénédicte, Janssen, Magdalena, Sokal, Etienne, Clapuyt, Philippe, Lerut, Jan, Reding, Raymond, and Otte, Jean-Bernard

Abstract

BACKGROUND: In most cases of total hepatectomy (TH) required for hepatoblastoma (HB), the retrohepatic inferior vena cava (IVC) has to be removed with the native liver for complete tumor excision. Because the liver graft procured by living donation has no IVC, a reconstruction of the recipient IVC is needed. We report our experience with living-related liver transplantation (LRLT) and IVC replacement in such cases. METHODS: Between May 1998 and December 1999, four children underwent TH, including IVC and LRLT with IVC replacement for otherwise irresectable HB after chemotherapy (SIOPEL 2 and 3 protocols). IVC reconstruction used an allogenic iliac vein procured from a cadaveric donor (bank graft) in two cases and an internal jugular vein procured from the donor parent in two cases. Median age and weight at surgery were 17 months (range 10-60) and 9.6 kg (range 8.3-17.9). RESULTS: In the living donors, there were two complications of the procurement: one intra-abdominal biliary collection and one subcutaneous abscess. In all four children, complete excision of the tumor could be achieved without any intra-operative complication. One patient died 5 months after LRLT due to lung metastases. Three patients were alive and well with no evidence of tumor recurrence 13-24 months after surgery. Reconstructed IVC was patent in two patients, and asymptomatic thrombosis occurred 2 years after operation in one patient. CONCLUSION: Total hepatectomy including the retrohepatic IVC is not a technical obstacle to LRLT. Therefore, scheduled surgery, at the best time after chemotherapy, can be considered in all patients with otherwise irresectable HBs.

Published
2002

32. Long-term survival and late graft loss in pediatric liver transplant recipients--a 15-year single-center experience.

Author

UCL - AGRO/BAPA - Département de biologie appliquée et des productions agricoles, UCL - MD/GYPE - Département de gynécologie, d'obstétrique et de pédiatrie, UCL - MD/CHIR - Département de chirurgie, Wallot, Michael A, Mathot, Michaël, Janssen, Magdalena, Hölter, Tanja, Paul, Kilic, Buts, Jean-Paul, Reding, Raymond, Otte, Jean-Bernard, Sokal, Etienne, UCL - AGRO/BAPA - Département de biologie appliquée et des productions agricoles, UCL - MD/GYPE - Département de gynécologie, d'obstétrique et de pédiatrie, UCL - MD/CHIR - Département de chirurgie, Wallot, Michael A, Mathot, Michaël, Janssen, Magdalena, Hölter, Tanja, Paul, Kilic, Buts, Jean-Paul, Reding, Raymond, Otte, Jean-Bernard, and Sokal, Etienne

Abstract

Increasing numbers of children undergo successful liver transplantation. Limited data exist on long-term survival and late graft loss. Survival and graft loss were studied in 376 primary liver graft recipients who survived more than 3 months after transplantation (80.5% of all primary graft recipients). Patient records were reviewed retrospectively for causes of graft loss. Risk factors were identified by analyzing graft, recipient, and posttransplant variables using multivariate Cox regression. One-, 5-, and 10-year actuarial graft survival rates in the study population were 94.6%, 87.3%, and 86.3%, respectively. Corresponding patient survival rates were 95.7%, 91.4%, and 90.4%. Forty-seven (12.5%) grafts were lost subsequently, 15 by patient death with preserved graft function. Survival rate after late retransplantation was 63.3%. Causes of late graft loss were infection (21.2%), posttransplant lymphoproliferative disease (PTLD, 21.2%), chronic rejection (17%), biliary complications (14.8%), and recurrence of malignant disease (8.5%). Independent risk factors for late graft loss and patient death included liver malignancy as primary disease, steroid resistant rejection, and PTLD. Graft loss rate was significantly increased for reduced-size grafts. Patients undergoing transplantation after 1991 and recipients of full-size grafts were more likely to survive. In conclusion, the long-term outcome for pediatric primary liver graft recipients surviving the early postoperative period is excellent except for patients with liver malignancy. There is no increased risk of late graft loss with the use of split or living related donor grafts. Technical complications are only a minor factor in late graft loss, but complications related to immunosuppression and infection remain a major hazard and must be addressed.

Published
2002

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