806 - The experience of pediatric living-donor liver transplantation at pediatric tertiary hospital in Mongolia

Otgonsuren Gonchigsuren, National Center for Maternal and Child Health of Mongolia, Ulaanbaatar, Ulaanbaatar, Mongolia; Manduul Batbayar, National Center for Maternal and Child Health, Ulaanbaatar, Ulaanbaatar, Mongolia; Ganbayar Luuzan, Children's Hospital & Medical Center, Ulaanbaatar, Ulaanbaatar, Mongolia; Odgerel Boldbaatar, National Center for Maternal and Child Health, Ulaanbaatar, Ulaanbaatar, Mongolia; Tsatsral Byambasuren, Chinbayan Co, LTD, Ulaanbaatar, Ulaanbaatar, Mongolia; Enkhsaikhan Purevjav, University of Tennessee Health Science Center (UTH, Memphis, TN, United States

Background: The most common indication for pediatric liver living-donor transplantation (LDLT) is a congenital biliary atresia (CBA) related liver cirrhosis (LC). Since 2011, more than 200 LDLT surgeries, including seven pediatric have been performed in Mongolia.

Objective: This report describes the first LDLT successfully performed at the National Center for Maternal and Child Health (NCMCH) in 2022.

Design/Methods: The LDLT candidate was a 7-year-old female patient with LC scored as pediatric end-stage liver disease (PELD) of 10.7 and child-Turcotte-Pugh (CTP) of 7/B. The patient underwent Kasai surgery at the age of 45 days due to CBA and had been hospitalized 3-4 times a year with LC, esophageal varices (EV), splenomegaly, and anemia. She had two EV ligation procedures. The tissue analysis of the donor mother’s liver found no evidence of portal inflammation, steatosis, or fibrosis.

Results: Measurements of the graft (285 g) showed the left lateral segment (S2/3) from left gastric artery (LGA), S4 from common hepatic artery, portal vein (PV) type 3 with left PV=1.1 cm and graft-to-recipient weight ratio (GRWR) of 1.64%. The graft was transferred to recipient’s operating room in 45 minutes. The recipient surgery started by a separation of the right and left triangles and coronary ligaments of the liver followed by separation of liver’s right lobe, S1 and left posterior portion from the inferior vena cava (IVC). The junction of the right PV with the IVC was distinguished and connected. The Hilar dissection to explant recipient’s cirrhotic liver was performed per standard guidelines. Recipient received methylprednisolone (10 mg/kg) immediately after liver explantation during nonhepatic 1 hr 20 min period. The recipient transferred to the intensive care unit after successful LT surgery lasted for 13.07 hrs. She received a triple (tacrolimus, mycophenolate mofetil, methylprednisolone) immunosuppressant treatment and was discharged after 30 days post-LT with normal liver graft function and good health condition. The patient followed-up weekly for the first 3 months and then monthly for clinical evaluation, liver and renal function analysis, and serum tacrolimus tests. A radiological assessment of hepatic vasculature was applied. Twenty-four-month follow-up exam revealed good condition of the patient, good quality of life, and normal graft function.

Conclusion(s): LDLT is a gold-standard treatment for improving the quality of life of children with PELD and save their lives. This successful LDLT in young patient empowered the team to implement a pediatric LT service at the NCMCH.