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APPROCCIO MINIINVASIVO NELLA DONAZIONE D ’ ORGANO A SCOPO TRAPIANTO PEDIATRICO

APPROCCIO MINIINVASIVO NELLA DONAZIONE D ’ ORGANO A SCOPO TRAPIANTO PEDIATRICO. Roberta Angelico MD, PhD, FEBS Chirurgia Epatobiliopancreatica e dei Trapianti Addominali Ospedale Pediatrico Bambino Gesù, IRCCS, Roma. CHIRURGIA ROBOTICA vs CHIRURGIA LAPAROSCOPICA TRADIZIONALE

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APPROCCIO MINIINVASIVO NELLA DONAZIONE D ’ ORGANO A SCOPO TRAPIANTO PEDIATRICO

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  1. APPROCCIO MINIINVASIVO NELLA DONAZIONE D’ORGANO A SCOPO TRAPIANTO PEDIATRICO Roberta Angelico MD, PhD, FEBS Chirurgia Epatobiliopancreatica e dei Trapianti Addominali Ospedale Pediatrico Bambino Gesù, IRCCS, Roma CHIRURGIA ROBOTICA vs CHIRURGIA LAPAROSCOPICA TRADIZIONALE Chieti, 5 Aprile 2019

  2. LIVING DONOR TRANSPLANTATION IN CHILDRENWhy? • Lack of size-match donor • No waiting on the transplant list • Elective procedure  ideal timing for transplantation • No deterioration / drop out / mortality on the waiting list Excellent outcomes!

  3. LIVING DONOR TRANSPLANTATION IN CHILDRENLimits • Availability of donor • Donor morbidity and mortality • Technical complexity and difficult organization KIDNEY TRANSPLANTATION LIVER TRANSPLANTATION UNOS Data 2018

  4. HOW TO IMPROVE LIVE DONATION? Donor mini-invasive surgery

  5. PEDIATRIC LIVING DONOR LIVER TRANSPLANTATION Left lateral segment: segments II-III Extended right lobe: segments I+IV-VIII 70%-75% whole liver volume 20%-25% whole liver volume IDEAL GRAFT-TO-RECIPIENT-WEIGHT-RATIO: 1.5-3%

  6. ADULT-TO-CHILD LDLT mini-invasive donor surgery • ≅ 200 laparoscopic donor procedures • Donor morbidity: 0-25% • Donor mortality: 0% • Conversion rate: 0-6% • Standardized technique Pan Au K et al. WJG, 2018 Han H et al. Dig Surgery, 2018

  7. PEDIATRIC LIVER TRANSPLANTATION ACTIVITYOspedale Pediatrico Bambino Gesù 34 100% 28 27 26 95% 24 15 15 3 -77% 30% Living donor liver transplantation

  8. Donor Mini-Invasive Left Lateral Sectionectomy OPBG experience Period: July 2016-April 2019 * Sequential living-related kidney transplantation

  9. Donor Mini-Invasive Left Lateral Sectionectomy OPBG experience Clavien Grade Grade 1: 0% Grade 2: 15% Grade 3: 0% Grade 4:0% Period: July 2016-April 2019 * Sequential living-related kidney transplantation

  10. LIVING DONOR KIDNEY TRANSPLANTATION Gold standards: • Pure laparoscopic nephrectomy • Hand-assisted nephrectomy Walther AE et al. Pediatric Transpl., 2015

  11. PEDIATRIC RENAL TRANSPLANTATION Ospedale Pediatrico Bambino Gesù 96% 83% 28 26 Log-Rank= 0.292 Log-Rank= 0.273 2018 43% living donor kidney transplantation

  12. Sequential laparoscopic liver-kidney procurement in the same living donor A C B D

  13. Conclusions • Mini-invasive approaches in donor liver resection might improve donor outcome and potentially increase the donor pool • Laparoscopic LLS for pediatric LDLT is considered a safe and feasible procedure with potential advantages when performed in expert centres • Pure laparoscopic and hand-assisted nephrectomy are the gold standard for living donor liver nephrectomy • The referral to pediatric transplant center with expertise in living donation and laparoscopic surgery is essential for good outcome

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