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Pediatric liver transplantation in Iran: evaluation of the first 50 cases
Seyed Mohsen Dehghani1, Ali Bahador, Siavash Gholami
1Organ Transplantation Center, Department of Pediatric Gastroenterology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. dehghanism@sums.ac.ir
Insights
Pediatric liver transplantation (LT) is a viable treatment for end-stage liver disease in Iran, with encouraging survival rates despite challenges. The study highlights the successful use of living-related and split liver grafts due to organ shortages.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Liver transplantation (LT) is the standard treatment for end-stage liver disease.
- Pediatric LT presents unique challenges and considerations compared to adult transplantation.
- Limited donor availability necessitates innovative graft utilization strategies.
Purpose of the Study:
- To evaluate the outcomes of pediatric liver transplantation in Iran.
- To analyze pretransplantation status, complications, and survival rates.
- To assess the feasibility and efficacy of using living-related and split liver grafts.
Main Methods:
- Retrospective study of 50 pediatric patients undergoing LT from April 1999 to March 2006.
- Data collection included pretransplantation details, graft types, surgical/medical complications, and survival.
- Analysis of outcomes based on graft source (living-related, deceased donor, split liver).
Main Results:
- The study included 50 pediatric patients (66% male, mean age 9.9 years).
- Common indications were cryptogenic cirrhosis (30%), autoimmune cirrhosis (24%), and biliary atresia (22%).
- Overall survival was 76%, with acute cellular rejection (44%) and infections (30%) as primary complications. Mortality rate was 24%.
Conclusions:
- Pediatric liver transplantation is a feasible and effective treatment in Iran.
- The use of living-related and split liver grafts is a necessary strategy to overcome organ shortages.
- The encouraging survival rates support the continued development of pediatric LT programs.
Abstract:
LT is nowadays accepted as the definitive therapy for end-stage liver disease. We report our experiences with pediatric LT using grafts from living related and DD. From April 1999 to March 2006, 50 infants and children who underwent LT were studied for pretransplantation status, medical and surgical complications and survival rate. There were 33 (66%) boys and 17 (34%) girls. The mean age of patients was 9.9 +/- 4.8 yr (range: 0.9-17.7) with a mean weight of 33.4 +/- 18.4 kg (range: 7.5-80). The main indications were cryptogenic cirrhosis (30%), autoimmune cirrhosis (24%), followed by biliary atresia (22%), Wilson disease (14%), progressive familial intrahepatic cholestasis (4%), fulminant hepatitis (4%) and tyrosinemia (2%). We used living-related donor in 14 (28%) and split liver in 5 (10%) cases and other patients received whole liver from DD. The mean follow-up of patients was 24.7 +/- 22.6 months (range: 1-72). The main postoperative complications were acute cellular rejection (44%) and infections (30%), whereas chronic rejection was seen in 26% of cases. The mortality rate was 24%. Overall mean survival (76% alive) was 63.5 +/- 5.7, 95% CI: 52.3-74.6. Our results demonstrate that pediatric LT is a feasible undertaking in Iran. Organ shortage in our area led to liberal use of living related and split liver techniques. The overall results of the pediatric LT in Iran are encouraging.
