Living donor liver transplantation in children with cholestatic liver disease: a single-center experience
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Published on: August 17, 2022
K Mizuta1, T Urahashi, Y Ihara
1Department of Transplant Surgery, Jichi Medical University, Oyama Municipal Hospital, Tochigi, Japan. Koimizu@jichi.ac.jp
Insights
Living donor liver transplantation (LDLT) is effective for pediatric cholestatic liver disease (CLD). This study shows excellent long-term patient survival rates, demonstrating LDLT
Area of Science:
- Pediatric Hepatology
- Transplantation Surgery
- Gastroenterology
Background:
- Cholestatic liver disease (CLD) is a primary indication for pediatric liver transplantation.
- Living donor liver transplantation (LDLT) offers a viable solution for pediatric CLD.
- This study retrospectively analyzes LDLT outcomes in children with CLD.
Purpose of the Study:
- To evaluate the effectiveness and outcomes of LDLT in pediatric patients with CLD.
- To assess patient survival rates and complication profiles following LDLT for CLD.
- To identify factors influencing outcomes in pediatric LDLT for CLD.
Main Methods:
- Retrospective analysis of 159 children with CLD undergoing 164 LDLTs between May 2001 and May 2011.
- Graft types, donor information, and recipient demographics were recorded.
- Postoperative complications, rejection rates, infections, and survival data were analyzed.
Main Results:
- Biliary atresia was the most common indication (91%). Parents were donors in 98% of cases.
- Common complications included biliary stricture (18%) and portal vein stenosis (13%).
- 1-, 5-, and 10-year patient survival rates were excellent at 98%, 97%, and 97%, respectively.
Conclusions:
- LDLT is an effective treatment for pediatric CLD with superior long-term patient survival.
- Careful management of postoperative complications is crucial for successful LDLT outcomes.
- LDLT provides a life-saving option for children with end-stage liver disease due to CLD.
Objectives:
Cholestatic liver disease (CLD) is the main indication for liver transplantation in children. This retrospective study evaluated the outcomes of living donor liver transplantation (LDLT) in children with CLD.
Methods:
One hundred fifty-nine children with CLD who underwent 164 LDLT between May 2001 and May 2011 were evaluated. Their original diseases were biliary atresia (n=145, 91%), Alagille syndrome (n=8, 5%), primary sclerosing cholangitis (n=2), and the others (n=4). The mean age and body weight of the recipients at LDLT was 42±53 months and 14.0±11.0 kg, respectively.
Results:
Parents were living donors in 98%. The left lateral segment was the most common type of graft (77%). There were no reoperations and no mortality in any living donor. Recipients' postoperative surgical complications consisted mainly of hepatic arterial problems (7%), hepatic vein stenosis (5%), portal vein stenosis (13%), biliary stricture (18%), intestinal perforation (3%). The overall rejection rate was 31%. Cytomegalovirus infection and Epstein-Barr virus disease were observed in 26% and 5%, respectively. Retransplantation was performed five times in four patients; the main cause was hepatic vein stenosis (n=3). Four patients died; the main cause was gastrointestinal perforation (n=2). The body height of Alagille syndrome patients less than 2 years old significantly improved compared with older patients after LDLT. The 1-, 5-, and 10-year patient survival rates were 98%, 97%, and 97%, respectively.
Conclusions:
LDLT for CLD is an effective treatment with excellent long-term outcomes.
