Abdominal Wall Closure in Less Than One-Year-Old Pediatric Liver Transplant Recipients

Introduction: The discrepancy between size of the graft and capacity of the abdominal cavity appears to be a critical problem for liver transplantation (LTx) in infants. Staged closure techniques with the help of synthetic or biologic materials enables successful LTx even in the presence of additional surgical interventions. In this study, we aimed to analyze the effects of primary (PC) or delayed closure (DAC) of the abdomen on graft and patient outcomes in pediatric LTx patients less than one-year of age. Material and Methods: The hospital records of all pediatric patients less than one-year-old with minimum 6-months follow‐up period who received primary LTx in Liver Transplantation Institute at İnönü University were analyzed retrospectively for the patient and allograft characteristics, abdominal closure techniques, postoperative complications and outcomes. Results: PC was achieved in 10 patients. Bogota bag closure was performed in 28 and skin only closure was implemented in 3 patients. The DAC group showed statistically significant higher GRWR values. The patient survival rates for PC and DAC groups were not statistically significant. Discussion: High DAC rate was attributed to the infant patient population similar to the literature regarding low body weight LTx recipients. Patient survival did not differ in PC and DAC groups supporting results of the current studies. Staged abdominal wall closure enables the LTx of very small pediatric patients safely. Future directions may comprise enhanced graft modifications and creation of more durable, inert and accessible biomaterials minimizing the re-operation requirements.