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Published on: August 17, 2022
Pediatric liver transplantation in Iran: a 9-year experience
A Bahador1, H Salahi, S Nikeghbalian
1Department of Hepatobiliary and Transplantation Surgery, Shiraz Transplant Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Insights
Pediatric liver transplantation (OLT) is a feasible treatment for end-stage liver disease, utilizing split and living donor grafts due to organ shortages. Outcomes in Iran were acceptable, despite challenges like vascular complications and rejection.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Liver transplantation (OLT) is a standard therapy for end-stage liver disease.
- A shortage of organ donors necessitates alternative strategies like split grafts and living related donors for pediatric liver transplants.
- This study reports on the experience with pediatric OLT over a nine-year period.
Purpose of the Study:
- To evaluate the feasibility and outcomes of pediatric liver transplantation (OLT).
- To analyze the impact of using split grafts and living related donors due to organ shortages.
- To identify complications and mortality factors in pediatric OLT.
Main Methods:
- A retrospective study of 138 infants and children who underwent OLT between April 1999 and August 2008.
- Data collected included pre-transplantation status, medical and surgical complications, and survival rates.
- Analysis focused on patient demographics, indications for OLT, donor types, and causes of mortality.
Main Results:
- The study included 138 patients (60.1% boys), with a mean age of 9.1 years. Main indications included Wilson's disease, cryptogenic cirrhosis, and biliary atresia.
- Living related donors (39.1%) and split livers (14.5%) were frequently used. Overall mortality was 27.5%, with higher rates in patients under 10 kg (58.8%).
- Vascular complications, primary nonfunction, and sepsis were leading causes of mortality. Chronic rejection and posttransplant lymphoproliferative disease were significant in discharged patients.
Conclusions:
- Pediatric OLT is a feasible procedure in Iran, with acceptable overall results.
- The study highlights the extensive use of living related and split-liver techniques due to organ scarcity.
- Strategies to mitigate complications such as chronic rejection are crucial for improving long-term outcomes in pediatric liver transplantation.
Background:
Liver transplantation (OLT) is accepted as the standard therapy for end-stage liver disease. The current shortage of organ donors has led to the use of split grafts and living related donors to provide timely liver transplants for these children. Herein we have reported our experience with pediatric OLT over a 9-year period.
Materials And Methods:
We retrospectively studied 138 infants and children who underwent OLT from April 1999 to August 2008 including pretransplantation status, medical and surgical complications, and survival.
Results:
There were 83 (60.1%) boys and 55 (39.9%) girls. The mean patient age was 9.1 +/- 5.6 years (range = 0.5-18) with a mean weight of 28.1 +/- 17.0 kg (range = 7-80). The main indications were Wilson's disease (20.3%); cryptogenic cirrhosis (16.7%); autoimmune cirrhosis (14.5%); biliary atresia (13.8%); tyrosinemia (9.4%); and progressive familial intrahepatic cholestasis (8.7%). We used living related donors in 54 (39.1%) and split livers in 20 (14.5%) cases with 64 (46.4%) patients receiving a whole liver from a deceased donor. The mean follow-up was 25.3 +/- 20.3 months (range = 1-100). The mortality rate was 27.5% with a 26.1% in-hospital mortality. The main causes of mortality were vascular complications (32.6%); primary nonfunction (19.6%); sepsis (17.4%); chronic rejection (17.4%); and biliary complications (6.5%). The mortality rate among patients under 10 kg (58.8%) was higher than that of patients over 10 kg (23.1%). Among those patients who were discharged from the hospital (73.9%), the most common cause of mortality was chronic rejection from noncompliance (n = 4), chronic rejection (n = 3 cases), or posttransplant lymphoproliferative disease (n = 2).
Conclusion:
Our results demonstrated that pediatric OLT is a feasible undertaking in Iran. The organ shortage in our area led to liberal use of living related and split-liver techniques. The overall results of pediatric OLT in Iran were acceptable.
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