Application of pediatric donation after brain death donors during split liver transplantation: an analysis of 8 cases

Objective To evaluate the feasibility and safety of using pediatric donation after brain death donors during split liver transplantation. Methods The clinical data were retrospectively reviewed for 8 pediatric recipients undergoing split liver transplantation with a donor age of 2.7-7 years. The clinical characteristics of donors/recipients, perioperative course, postoperative recovery and complications along with graft and recipient survival rate were analyzed. Results The split procedure was performed ex situ (n=3) and in situ (n=1), all liver grafts were split into left lateral lobes and extended right lobes. The recipients were children aged 4.7-105.5 months. The mean follow-up period was (8.1±0.6) months and the graft/recipient survival rates approached 100%. Graft functions remained normal in all recipients at the end of follow-ups. Two recipients undergoing liver grafting with long cold ischemia time exhibited slower recovery of graft function. Pathological examination of graft biopsy indicated ischemic and hypoxic changes. Portal vein stenosis occurred in one recipient. Percutaneous transhepatic portal vein balloon dilatation was performed and the recipient recovered well. Cytomegalovirus infection occurred in 5/8 recipients and serum virological marker returned to normal after ganciclovir therapy. The youngest donor age was 2.7 years and both recipients of donor liver recovered well. Conclusions Split liver transplantation with a donor age of 2.7-7.0 years may achieve ideal clinical outcomes in well-matched donors and recipients. Key words: Liver transplantation; Brain death; Child