GHÉP GAN TRẺ EM TỪ NGƯỜI HIẾN CHẾT NÃO: NHÂN HAI TRƯỜNG HỢP TẠI BỆNH VIỆN NHI ĐỒNG 2

Abstract

Background: Pediatric liver transplantation is an established, life-saving therapy for children with end-stage liver disease in Vietnam, primarily utilizing living donors. However, deceased donor liver transplantation in pediatric recipients has not been previously documented nationally. Case presentation: Case 1: A 21-month-old girl (weight 6.8 kg) with cirrhosis secondary to progressive familial intrahepatic cholestasis type 1 (PFIC1) (PELD score 26) underwent orthotopic liver transplantation using a left lateral segment graft (segments II–III) from a deceased donor. The intraoperative and immediate postoperative courses were uneventful. Four months post-LT, the patient had chronic diarrhea unchanged after transplantation, while serum bilirubin normalized but liver enzymes remained mildly elevated (AST 139 U/L, ALT 225 U/L, GGT 168 U/L). Percutaneous liver biopsy demonstrated moderate steatohepatitis. Six months post-LT, she underwent biliary diversion (internal bile drainage to the transverse colon). Following diversion, stool frequency decreased to 2–3 times per day, oral intake improved, and graft function stabilized. Case 2: A 15-month-old boy (weight 10 kg) with cirrhosis secondary to biliary atresia after Kasai portoenterostomy and portal hypertension (PELD score 26) received a split left lateral segment graft (segments II–III) from a deceased donor. The operation proceeded smoothly. Postoperatively, the patient developed massive ascites (up to 3,000 mL per day). Doppler ultrasonography and contrast-enhanced computed tomography revealed venous outflow obstruction of the segment III hepatic vein. Surgical revision was performed with reconstruction of the segment III hepatic vein to the inferior vena cava using a synthetic interposition graft. On postoperative day 1, he underwent re-exploration for hemostasis. The subsequent recovery was uneventful, with normalization of graft function and satisfactory growth at four months post-liver transplantation. Conclusion: Liver transplantation in pediatric recipients from deceased donors is a safe and effective therapeutic option.