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Updated: Jul 10, 2026
Orthotopic Liver Transplantation in Rats
Published on: July 1, 2012
[Orthotopic liver transplantation in children younger than one year]
1Departamento de Cirugía Pediátrica, Hospital Universitario La Paz, Madrid.
Insights
Orthotopic liver transplantation (OLT) in infants shows improved survival rates with experience. Living-related donor and split grafts offer better outcomes and shorter cold ischemia times (CIT) compared to whole grafts, which are linked to higher graft loss.
Area of Science:
- Pediatric Surgery
- Hepatology
- Transplantation Immunology
Context:
- Orthotopic liver transplantation (OLT) in children under one year old faces challenges including high waiting list mortality.
- Alternative graft sources are crucial for improving outcomes in this vulnerable population.
Purpose:
- To evaluate the outcomes of OLT in infants younger than one year, focusing on graft and patient survival.
- To analyze the impact of different graft types and transplantation periods on survival rates and graft loss.
Summary:
- A review of 103 OLTs in 83 infants revealed significant improvements in 5-year patient and graft survival across three periods (1986-1995, 1996-2000, 2001-2005), with rates increasing from 45%/65% to 94%/97%.
- Living-related donor (93% survival) and split grafts (100% survival) demonstrated superior outcomes compared to whole (63%) and reduced-lobe grafts (68%).
- Whole grafts were associated with a higher rate of graft loss (28%), primarily due to surgical complications.
Impact:
- Survival rates for OLT in infants are comparable to older age groups, highlighting advancements in pediatric liver transplantation.
- Shorter cold ischemia times (CIT) were observed with living-related donor and split grafts, suggesting improved graft viability.
- Graft loss is frequently linked to sepsis and immunosuppression issues, underscoring the need for optimized post-transplant management.
Background:
Orthotopic liver transplantation (OLT) in children younger than one year is associated to higher waiting list mortality and alternative graft sources are required. We present our experience with this particular group of age.
Methods:
Infants younger than one year who received an OLT between 1986 and 2005 were reviewed focused on graft and children survival depending on period and type of graft. Periods were 1:1986-1995; 2:1996-2000 and 3:2001-2005. We also evaluate cold ischemia time (CIT), graft lost causes and differences between CIT and anhepatic time (AT) depending on graft type.
Results:
Eighty-three children received 103 OLT. Liver transplant indications were 59 (72%) biliary atresia, 8 (10%) metabolic causes, 6 (8%) liver failure, 3 (4%) cirrhosis and 7 (6%) miscelaneous. Patient and graft survival after 5 years was increased depending on period: 45% and 65% on period 1, 70% and 80% on period 2, 94% y 97% on period 3 (p < 0.0198). Thirty-seven grafts were reduced lobes (42%); 8 (21%), 17 (45%) and 12 (35%) during periods 1, 2 and 3 respectively and their 5 years survival rate was 68%. Twenty-four were whole grafts (31%); 11 (45%), 10 (45%) and 3 (14%) during periods 1, 2 and 3 and their 5 years survival rate was 63%. Fourteen grafts were living-related donor (16%); 1 (7%), 2 (14%) and 11 (79%) during periods 1, 2 and 3 and their 5 years survival rate was 93%. Eight (11%) were split; 0, 1 (12%) and 7 (90%) during periods 1, 2 and 3 and their 5 years survival rate was 100%. Average CIT depending on graft was: living donor 5,5 hours (IQR: 4-7), split 6,1 hours (IQR: 5-8), whole 9.2 hours (IQR: 6-11) and reduced 8.5 hours (IQR: 6-11) (p < 0.05). Average AT depending on graft was: living donor 1 hour (IQR: 0.5-1.5), split 1 hour (IQR: 0.5-1.4), whole 1,1 hours (IQR: 0.5-1.5) (p > 0.1). Twenty-four grafts were lost (28%): 10 (41%) were surgical related causes and 6/10 (60%) of them were whole grafts.
Conclusions:
Survival rates in children younger than one year are similar to another groups of age. There was a significant increase on graft survival according to transplantation group experience. A higher rate of graft lost is associated to whole grafts. Most frequent reasons of graft lose were related to sepsis and immunosuppresion. A significant shortening of CIT is observed in related living donor and split grafts.
