Goetz, Markus and Jurczyk, Maria and Grothues, Dirk and Knoppke, Birgit and Junger, Henrik and Melter, Michael and Schlitt, Hans J. and Brunner, Stefan M. and Brennfleck, Frank W. (2023) Biological abdominal wall expansion in pediatric liver recipients after transplantation with large-for-size organs. PEDIATRIC TRANSPLANTATION, 27 (1). ISSN 1397-3142, 1399-3046
Full text not available from this repository. (Request a copy)Abstract
Background After pediatric split liver transplantation, intra-abdominal loss of domain due to large-for-size left lateral grafts is a frequent problem for fascial closure and potentially leads to reduced liver perfusion and abdominal compartment syndrome. Therefore, delayed fascial closure with the use of temporary silastic meshes and reoperation or alternative fascial bridging procedures are necessary. Methods Between March 2019 and October 2021, biologic meshes were used for abdominal wall expansion in 6 cases of pediatric split liver transplantation. These cases were analyzed retrospectively. Results One male and 5 female children with median age of 6 months (range: 0-57 months) and weight of 6 kg (range: 3.5-22 kg) received a large-for-size left lateral graft. Graft-to-recipient weight ratio (GRWR) was 4.8% (range: 1.5%-8.5%) in median. Biologic mesh implantation for abdominal wall expansion was done in median 7 days (range: 3-11 days) after transplantation when signs of abdominal compartment syndrome with portal vein thrombosis in 3 and of the liver artery in 1 case occurred. In 2 cases, bovine acellular collagen matrix and 4 cases ovine reinforced tissue matrix was used. Median follow-up was 12.5 months (range: 4-28 months) and showed good liver perfusion by sonography and normal corporal development without signs of ventral hernia. One patient died because of fulminant graft rejection and emergency re-transplantation 11 months after the initial transplantation. Conclusions Biologic meshes can be used as safe method for abdominal wall expansion to achieve fascial closure in large-for-size liver transplant recipients. Usage for primary fascial closure can be considered in selected patients.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | RECTUS FASCIA; HERNIA REPAIR; CLOSURE; MESH; MATRIX; SAFE; abdominal compartment syndrome; complications of liver transplantation; large-for-size grafts; pediatric liver transplantation; surgical complications |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Chirurgie Medicine > Lehrstuhl für Kinder- und Jugendmedizin |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 05 Mar 2024 08:47 |
| Last Modified: | 05 Mar 2024 08:47 |
| URI: | https://pred.uni-regensburg.de/id/eprint/56592 |
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