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Published on: August 17, 2022
Chilean experience in liver transplantation for acute liver failure in children
1Centro de Trasplante Clinica Las Condes and the Hospital Luis Calvo, Santiago, Chile. muribem@clc.cl
Insights
Pediatric liver transplants for acute liver failure (ALF) show promising survival rates. Living donor transplants for ALF are a viable option with low morbidity and no mortality.
Area of Science:
- Pediatric Hepatology
- Transplant Surgery
- Critical Care Medicine
Background:
- Acute liver failure (ALF) in children is a critical condition with high mortality.
- Orthotopic liver transplant (OLT) is often the only treatment option for pediatric ALF.
- This study presents OLT experience for pediatric ALF in Chile.
Purpose of the Study:
- To report on the outcomes of pediatric liver transplantation for ALF in Chile.
- To analyze demographics, etiologies, surgical techniques, and complications.
- To evaluate long-term results of OLT in pediatric ALF patients.
Main Methods:
- 52 pediatric patients with ALF underwent OLT between 1994 and 2009.
- Data collected prospectively included demographics, etiology, surgical methods, and complications.
- Graft types included cadaveric (reduced or whole) and living-related donors.
Main Results:
- The most frequent known etiology was hepatitis A (18%), with undetermined etiology in 50% of cases.
- Patient survival at 1, 5, and 10 years was 80%, 72%, and 72%, respectively.
- Graft survival at 1, 5, and 10 years was 79%, 69%, and 50%, respectively.
Conclusions:
- Pediatric OLT for ALF in Chile yielded results comparable to international series.
- Living donor transplantation for ALF is a recommended option, demonstrating low morbidity and no mortality.
- Further consideration of living donor options is warranted for pediatric ALF patients.
Background:
Acute liver failure (ALF) in children is a life-threatening condition, associated with high mortality, and in almost one third of the cases, with no other therapeutic option than orthotopic liver transplant (OLT). The aim of this study was to present our experience with OLT for ALF in pediatric patients in Chile. Patients fulfilling the criteria for ALF who were transplanted in our centers were prospectively included in an excel Microsoft database. We analyzed demographics, etiology, surgical techniques, complications, and long-term results.
Patients And Methods:
Between 1994 and 2009, we transplanted 52 pediatric patients with ALF. The most frequent known etiology was acute hepatitis A in 9 cases (18%), but in 26 cases (50%) it was impossible to determine the etiology. Thirty- one patients were males (63%). The overall mean age was 7.5 years and the mean weight, 28.1 kg. Thirty-five (67%) received a cadaveric graft. Among them in 18 cases (34%) the liver had to be reduced but 17 (33%) received whole livers. There were 17 (33%) recipients of living-related livers. Twenty-two patients needed reoperation, including 13 due to surgical complications (59%) and 9 (41%) as planned interventions. Ten patients were retransplanted.
Results:
Actuarial survival of patients at 1 year was 80% and at 5 and 10 years, 72%. Graft survival at 1 year was 79%, at 5 years 69%, and at 10 years 50%.
Conclusion:
We have reported a series of pediatric liver transplant patients due to ALF whose results were comparable to other reported series. Living donor transplantation for ALF should be considered and offers a low morbidity rate without mortality.
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