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Liver transplantation in children.
R W Busuttil1, P Seu, J M Millis
1Department of Surgery, University of California, Los Angeles.
Annals of Surgery
|January 1, 1991
Summary
Pediatric liver transplantation offers a high survival rate of 80% for end-stage liver disease. Key factors for success include technical precision, early intervention, and effective immunosuppression strategies like OKT3 for rejection.
Area of Science:
- Pediatric Surgery
- Hepatology
- Immunology
Background:
- Liver transplantation is the optimal treatment for end-stage liver disease.
- Pediatric liver transplantation presents unique challenges, including technical difficulties and graft failure.
Purpose of the Study:
- To analyze the experience of 103 pediatric liver transplant patients.
- To identify factors crucial for favorable outcomes in pediatric liver transplantation.
Main Methods:
- Detailed technical aspects of vascular reconstruction were emphasized.
- Preoperative exchange transfusions and specific immunosuppression protocols (cyclosporine, OKT3) were employed.
- Antifungal prophylaxis was administered to high-risk patients.
Main Results:
- An 80% patient survival rate was achieved, with actuarial survival at 5 years at 77%.
- Hepatic artery thrombosis occurred in 13% of patients; ABO identical grafts showed significantly better survival (96% vs. 60%).
- Despite renal function impairment in 54%, 90% of children showed improved growth and development.
Conclusions:
- Pediatric liver transplantation is the treatment of choice for end-stage liver disease and should be considered early.
- Technical precision, aggressive retransplantation, antifungal prophylaxis, and judicious immunosuppression are vital for enhancing survival.
- Pediatric liver transplantation significantly improves growth, development, and functional status in recipients.