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Paediatric liver transplantation [corrected] in Melbourne: the first 50 patients
W Hardikar1, A L Smith, P Angus
1Department of Gastroenterology, Royal Children's Hospital, Flemington Rd., Parkville, Victoria 3052, Australia. hardikaw@cryptic.rch.unimelb.edu.au
Insights
This study reports on 50 pediatric liver transplants (LT), showing 1-year survival of 88% and 10-year survival of 85%. Outcomes were favorable, with survivors achieving age-appropriate activities.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplantation Immunology
Background:
- Liver transplantation (LT) is a critical treatment for end-stage liver disease in children.
- The Victorian Liver Transplant Unit initiated its pediatric program in 1988.
- Long-term outcomes data for pediatric LT are essential for program development and patient care.
Purpose of the Study:
- To review the initial outcomes of the first 50 pediatric liver transplant (LT) recipients at the Victorian Liver Transplant Unit.
- To identify common indications for LT in the pediatric population.
- To assess survival rates and functional outcomes post-LT.
Main Methods:
- Retrospective case record review of 50 pediatric patients (18 years or younger) who underwent LT between December 1988 and December 2000.
- Analysis of patient demographics, indications for LT, transplant details, and post-operative outcomes.
- Calculation of actuarial survival rates at 1 and 10 years.
Main Results:
- Fifty pediatric patients underwent 53 LTs, with common indications including biliary atresia (32%), metabolic disease (26%), and acute hepatic necrosis (26%).
- Actuarial survival rates were 88% at 1 year and 85% at 10 years.
- Survival was highest in children aged 3-14 years (95%) and lowest in those weighing <8 kg (66%). Most deaths (6/7) occurred within the first week post-transplant.
- All 43 survivors are engaged in age-appropriate activities.
Conclusions:
- Pediatric liver transplantation at the Victorian Liver Transplant Unit demonstrates favorable survival rates comparable to national and international benchmarks.
- Early post-transplant mortality is a significant factor, emphasizing the need for intensive perioperative care.
- Successful LT enables pediatric recipients to achieve significant long-term functional recovery and reintegration into society.
Abstract:
To report the outcomes of the first 50 paediatric patients who have undergone liver transplantation (LT) at the Victorian Liver Transplant Unit, a retrospective review of case records was carried out. From December 1988 to December 2000, 108 patients 18 years or younger were referred for LT; 50 of these underwent a total of 53 transplants. The most common indications were biliary atresia (32%), metabolic disease (26%), and acute hepatic necrosis (26%). The majority of deaths (6/7) occurred in the 1st week after LT. The actuarial survival at 1 year was 88% (95% CI 75% to 94%) and at 10 years 85% (95% CI 71% to 93%). Survival rates were highest for children aged 3 to 14 years (95%) and lowest in those weighing less than 8 kg at the time of LT (66%). All 43 survivors are attending age-appropriate activities including kindergarten, school, and employment. The survival of patients undergoing LT in this unit compares favourably with those recorded by the Australia and New Zealand Transplant Registry and is commensurate with that reported by larger paediatric transplant programs overseas.
