Early relaparotomy following pediatric living-donor liver transplantation: experience in an Indonesian national referral hospital

Tri Hening Rahayatri; Alif Rizqy Soeratman; Rusdah Binti Muhammad Amin; Dalia Benchamas Margiadi; Riana Pauline Tamba; Mureo Kasahara

doi:10.1136/wjps-2022-000511

Early relaparotomy following pediatric living-donor liver transplantation: experience in an Indonesian national referral hospital

World J Pediatr Surg. 2023 Feb 1;6(1):e000511. doi: 10.1136/wjps-2022-000511. eCollection 2023.

Authors

Tri Hening Rahayatri^{1

2}, Alif Rizqy Soeratman³, Rusdah Binti Muhammad Amin⁴, Dalia Benchamas Margiadi⁴, Riana Pauline Tamba^{1

2}, Mureo Kasahara⁵

Affiliations

¹ Division of Pediatric Surgery, Department of Surgery, Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo, Central Jakarta, Indonesia.
² Division of Pediatric Surgery, Department of Surgery, Universitas Indonesia Fakultas Kedokteran, Central Jakarta, Indonesia.
³ Department of Surgery, Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo, Central Jakarta, Indonesia.
⁴ Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo, Central Jakarta, Indonesia.
⁵ Department of Transplantation, National Center for Child Health and Development, Setagaya-ku, Japan.

Abstract

Background: Living donor liver transplantation (LDLT) remains the only curative treatment for children with end-stage liver disease; however, complications of the procedure are associated with indications for early relaparotomy. Several risk factors associated with early relaparotomy after liver transplantation include pediatric end-stage liver disease (PELD) score, warm ischemia time (WIT), and cold ischemia time (CIT). Our study investigated the incidence and indications of early relaparotomy in postoperative pediatric LDLT recipients and compared the outcomes with patients who did not require relaparotomy.

Methods: A retrospective cohort study of pediatric LDLT recipients from Cipto Mangunkusumo Hospital, Jakarta, Indonesia, was collected from 2010 to August 2022. Indications for early relaparotomy were investigated. Factors analyzed in the early relaparotomy group compared with the nonrelaparotomy group included intraoperative blood loss, surgery duration, CIT, WIT, and PELD score.

Results: The highest indication for early relaparotomy was biliary leakage. Most patients who underwent early relaparotomy only had one incidence of relaparotomy (60%). The surgery duration in subjects with early relaparotomy was longer by a median of 3 hours compared with those without early relaparotomy (p=0.289). Intraoperative blood loss was greater in early relaparotomy subjects than in subjects without early relaparotomy (95 vs 77 mL/kg, p=0.552). Other factors, such as PELD score, CIT, and WIT, also showed no significant difference between the two groups.

Conclusion: Biliary leakage was the most common indication for early relaparotomy in our center. There were no preoperative or intraoperative factors that significantly influenced the incidence of early relaparotomy due to the limited sample size and the early advancement of our liver transplant center.

Keywords: jaundice; pediatrics.