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Published on: November 7, 2020
Outcome of liver transplantation for children with liver disease
1Department of Paediatrics, Children's Medical Institute, National University Hospital, 5 Lower Kent Ridge Road, Singapore. paeawm@nus.edu.sg
Insights
Paediatric liver transplants significantly improve outcomes for children with liver failure. This review of 46 transplants shows a 5-year survival rate of 81.8%, demonstrating the procedure
Area of Science:
- Pediatric surgery
- Hepatology
- Transplant immunology
Background:
- Liver transplantation has transformed outcomes for children with acute liver failure and end-stage liver disease.
- The National Liver Transplant Programme initiated in 1990 provides a critical context for evaluating pediatric liver transplant outcomes.
Purpose of the Study:
- To review the outcomes of all pediatric liver transplants performed since the program's inception in 1990.
- To assess survival rates, indications, and complications associated with pediatric liver transplantation.
Main Methods:
- A retrospective review was conducted on all pediatric liver transplants performed between 1990 and December 2004.
- Data analysis included patient demographics, transplant indications, graft survival, rejection rates, and causes of mortality.
Main Results:
- 46 liver transplants were performed in 43 children, with biliary atresia being the most common indication (71.7%).
- Living-related transplants comprised 63% of cases. Overall actuarial one- and five-year survival rates were 85.7% and 81.8%, respectively.
- Common complications included hepatic artery thrombosis, acute rejection (19.6%), and sepsis; nine deaths occurred due to various causes.
Conclusions:
- Pediatric liver transplantation is an established and effective intervention for end-stage liver disease and metabolic disorders.
- The outcomes reported in this study are comparable to those of leading international liver transplant centers.
Introduction:
The advent of liver transplantation has revolutionised the outcome of children with both acute liver failure and chronic end-stage liver disease. The aim of this study was to review the outcome of all paediatric liver transplants performed since the National Liver Transplant Programme began in 1990.
Methods:
A retrospective review of all paediatric liver transplants from 1990 to December 2004 was performed.
Results:
46 liver transplants were performed in 43 children, of whom 23 (53.3 percent) were female. Median age at transplant was 21 months (range 11 months to 14 years). The most common indication for liver transplant was biliary atresia (71.7 percent). Living-related transplants accounted for 63 percent (29). Re-transplant rate was 6.5 percent with allograft loss as a result of hepatic artery thrombosis (two) and hepatic vein thrombosis (one). Tacrolimus was the primary immunosuppressive agent used in 89 percent of patients, with a 19.6 percent incidence of acute allograft rejection within the first six months. There were nine deaths. They were related to portal vein thrombosis (three), chronic rejection (one), sepsis (two), post-transplant lymphoproliferative disease (two) and primary graft non-function (one). Overall actuarial one- and five-year survival rate was 85.7 percent and 81.8 percent, respectively.
Conclusion:
Liver transplantation is an established form of intervention for end-stage liver disease and a variety of liver-related metabolic disease. Our results are comparable to those of well-established liver transplant centres.
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