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Liver transplantation in infants
1Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong.
Insights
Pediatric liver transplantation in infants under one year is challenging but achievable, demonstrating high survival rates. This study suggests that young age should not preclude infants from receiving life-saving liver transplants.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplant Surgery
Background:
- Infants under one year are considered a high-risk group for liver transplantation.
- Previous reports highlight the challenges associated with performing liver transplants in this age demographic.
Purpose of the Study:
- To review the experience of orthotopic liver transplantation in children younger than one year.
- To evaluate the feasibility and outcomes of liver transplantation in this high-risk pediatric population.
Main Methods:
- Retrospective review of 9 children under one year who underwent liver transplantation.
- Procedures included 6 living-related liver transplants and 3 reduced-size liver transplants.
- Transplantations were performed between December 1993 and June 1997.
Main Results:
- Five reoperations were required due to early complications such as bleeding and anastomotic leakage.
- Late complications included biliary-enteric strictures and hepatitis requiring retransplantation.
- Excellent outcomes were observed: 100% patient survival and 89% graft survival with good liver function; no hepatic artery thrombosis occurred.
Conclusions:
- Liver transplantation in infants under one year is technically demanding but feasible.
- The procedure can be performed with good outcomes, indicating age alone should not be a contraindication.
- This study supports the consideration of liver transplantation for infants regardless of age.
Purpose:
In view of the earlier reports that children below 1 year of age constitute a high-risk group for liver transplantation, the authors reviewed their experience in performing orthotopic liver transplantation in this age group.
Methods:
The records of 9 children aged less than 1 year who underwent 6 living-related liver transplants and 3 reduced-size liver transplants between December 1993 and June 1997 were reviewed.
Results:
Five reexplorations were required for 3 children who had 1 or more of the following early complications: bleeding from hepatic vein to inferior vena cava anastomosis (n = 1), right hepatic vein stump bleeding (n = 1), intraabdominal hematoma (n = 2), jejuno-jejunostomy leakage (n = 1), and colonic perforation (n = 1). Late complications include stricture at the biliary-enteric anastomosis requiring percutaneous balloon dilatation (n = 3) and hepatitis of undetermined etiology requiring retransplantation (n = 1). There was no hepatic artery thrombosis despite the small arteries available for anastomosis. Follow-up ranged from 19 to 61 months (mean, 40 months). Patient survival rate was 100%, and graft survival with good liver function was 89%. All living donors, 2 fathers and 4 mothers, are well.
Conclusions:
Liver transplantation in infants less than 1 year of age is technically demanding but feasible and still can be performed with a good outcome. Age alone (under 1 year) should not be considered as a contraindication for liver transplantation.