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[Liver transplantation in infants younger than one year of age]
J Murcia1, M López Santamaría, M Gámez
1Departamento de Cirugía, Hospital Infantil La Paz, Madrid.
Insights
Pediatric liver transplants (TH) in infants under one year old show improving survival rates, comparable to older children. Transplant center experience significantly influences outcomes for this young patient group.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplant Immunology
Context:
- Advancements in surgical techniques have reduced age-related risks in pediatric liver transplantation.
- Infants under one year old previously faced higher risks in liver transplant procedures.
Purpose:
- To evaluate the outcomes of pediatric liver transplants in children younger than one year.
- To compare these outcomes with older pediatric recipients.
- To assess the impact of transplant center experience on outcomes in this cohort.
Summary:
- A review of 44 pediatric liver transplants in patients under one year old, with 27 performed in the last five years.
- Survival rates for grafts and patients were slightly lower in the younger group but improved significantly in recent years (71.4% at 1 year, 61.9% at 5 years).
- Younger patients presented with more severe clinical conditions (UNOS III-IV: 43% vs 13.1%) and higher rates of graft reduction (54% vs 21%), with no increased complication rates.
Impact:
- Pediatric liver transplantation in infants under one year is feasible with outcomes approaching those of older children.
- Increased experience at transplant centers correlates with improved results for infant liver recipients.
- This study highlights the importance of specialized centers for managing complex pediatric liver transplant cases.
Background:
The development of the surgical techniques of hepatic division has maken that the young age (less than one year old) is no longer considered a risk factor in the pediatric liver transplant (TH).
Aim:
To show our experience with the TH in children younger than one year, comparing these results with the rest of the series and in second place to analyze if a bigger experience improves the results of the TH in this group of patients.
Methods:
44 patients that received a TH with less than a year of age are reviewed. Among them, 27 were in the last five years. The survival indexes of the graft and the patient are determined at 1, 5 and 10 years comparing them with three rest of the series.
Results:
The grafts and patients survival was slightly inferior in the less than one year old, although in the last five years it improved 71.4% vs 82.1% at one year follow-up, and 61.9 in front of 74.5% at five years. The clinical situation of the patients that were transplanted before the year of life was worse: 43% (UNOS III, IV) in front of 13.1% in the same stadiums in the rest of the serie. In the younger patients, 54% of the grafts were reduced, versus 21% in the older. There were not a higher rate of complications in the young group.
Conclusions:
In spite of the difficulties of the TH in children younger than one year of age, the results are not very different from those obtained in the rest of the patients. In these results the experience of the transplant center have a great influence.