Living donor liver transplantations in low-weight (≤7 kg) pediatric patients with Alagille syndrome (ALGS) and other liver diseases have similar survival rates as normal-weight patients despite having longer stays in the intensive care unit (ICU) and higher rates of complications, according to a new study published in the Journal of Pediatric Surgery.

The researchers also found that hepatic artery thrombosis (HAT) and retransplantation rates were similar between both patient groups.

“The use of living donors as shown in this series may represent an advantage, given that such donors are usually healthy (by definition), young and the surgery can be scheduled for an appropriate time in usual working hours,” the authors said.

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“As shown previously by our group, the most important determinant of post-transplant survival was the occurrence of early vascular complications (HAT and [early portal vein thrombosis]).”

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The research team retrospectively evaluated long-term outcomes among 1078 primary living donor liver transplantations cases in Brazil between January 1995 and December 2020. Forty-one patients had ALGS.

The patients were divided into 2 groups: body weight (BW) ≤7 kg and BW >7 kg, and 38.7% had previously undergone surgery. The authors noted an increasing trend in transplants in low BW children compared with normal BW patients over time.

The low BW patients needed significantly more blood transfusions, greater use of vascular grafts, and mesh abdominal closure. Higher rates of HAT were also observed in the low BW patients, but the difference did not reach significance. Portal vein complication rates were significantly greater in the low BW group, while HAT and retransplant rates were similar. Patients with low BW did require longer ICU and hospital stays, the authors concluded.


Seda Neto J, Chapchap P, Feier FH, et al. The impact of low recipient weight [d 7kg] on long-term outcomes in 1078 pediatric living donor liver transplantations. J Pediatr Surg. Published online May 22, 2022. doi:10.1016/j.jpedsurg.2022.05.014