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Updated: Jun 11, 2026
Heterotopic Auxiliary Rat Liver Transplantation With Flow-regulated Portal Vein Arterialization in Acute Hepatic Failure
Published on: September 13, 2014
Improved outcomes in pediatric liver transplantation for acute liver failure
Tamir Miloh1, Nanda Kerkar, Sanobar Parkar
1Department of Pediatrics and Recanati Miller Transplant Institute, Department of Surgery, Mount Sinai Hospital, New York, NY, USA. tamir.miloh@mountsinai.org
Insights
Orthotopic liver transplantation (OLT) offers a life-saving option for pediatric acute liver failure (ALF). This study shows no difference in outcomes between various graft types in pediatric OLT for ALF, supporting liberal use of segmental grafts.
Area of Science:
- Hepatology
- Pediatric Gastroenterology
- Transplantation Surgery
Background:
- Acute liver failure (ALF) in children is a critical condition requiring timely intervention.
- Orthotopic liver transplantation (OLT) is a vital treatment option for pediatric ALF.
- Evaluating outcomes in pediatric OLT is crucial for improving patient survival and graft function.
Purpose of the Study:
- To assess the outcomes of pediatric OLT for ALF.
- To compare the efficacy of different graft types in pediatric OLT for ALF.
- To identify factors associated with patient survival and graft loss in pediatric OLT for ALF.
Main Methods:
- Retrospective review of pediatric OLT cases for ALF between 1992 and 2007.
- Analysis of patient demographics, graft types (deceased donor whole/split, living donor), and waiting times.
- Statistical analysis of patient survival, graft survival, and associated clinical factors.
Main Results:
- Out of 142 children with ALF, 77 underwent OLT with a median waiting time of four days.
- One- and five-year patient survival rates were 87% and 80%, respectively; graft survival rates were 83% and 79%.
- No significant differences in survival or complications were observed between different graft types (deceased vs. living donor, whole vs. split grafts).
Conclusions:
- This study represents the largest single-center experience with OLT in pediatric ALF.
- Outcomes in pediatric OLT for ALF are comparable across different graft types.
- Liberal utilization of segmental grafts may facilitate earlier transplantation and contribute to favorable outcomes in this high-risk pediatric population.
Unlabelled:
OLT is a life-saving option for ALF.
Aim:
To evaluate our outcomes in pediatric OLT for ALF.
Methods:
Retrospective review of our data between 1992 and 2007.
Results:
Of 142 children with ALF, 126 were listed, of which 40 spontaneously improved, nine died, and 77 underwent OLT (median waiting time four days). Fifty-three children received deceased donor grafts (34 whole and 19 split grafts), and there were 24 living donor grafts. The one- and five-yr patient survival was 87% and 80%, and graft survival 83% and 79%, respectively. Thirteen patients died after OLT, and there were nine retransplants in seven patients. Patient weight, length of stay, creatinine, and infection were significantly associated with death; increased weight and black ethnicity were associated with graft loss on univariate analysis, but not on multivariate analysis. There were no significant differences in patient survival (one and five yr), graft loss, or other complications between the groups.
Conclusion:
We report the largest single-center study of OLT in pediatric ALF, demonstrating no difference in outcomes between different graft types. Our liberal use of segmental grafts may allow earlier OLT in this high-risk cohort and contribute to our excellent outcomes.
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