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Published on: August 17, 2022
Pediatric liver transplant: a single-center study of 100 consecutive patients
Turan Kanmaz1, Yücel Yankol, Nesimi Mecit
1Organ Transplantation Center, Şişli Memorial Hospital, Istanbul, Turkey.
Insights
Living-donor liver transplants are a safe and effective option for pediatric patients with end-stage liver disease. This study shows high survival rates and minimal complications in children receiving liver transplants from living donors.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplantation Medicine
Background:
- End-stage liver disease (ESLD) in children presents significant challenges due to organ scarcity.
- Pediatric liver transplantation is a critical treatment for ESLD, with living-donor liver transplantation (LDLT) emerging as a vital alternative.
- Limited availability of deceased donors necessitates exploration of alternative strategies like LDLT.
Purpose of the Study:
- To evaluate the outcomes of 100 consecutive pediatric liver transplant patients.
- To assess the safety and efficacy of living-donor liver transplantation in a pediatric cohort.
- To analyze complications and survival rates in pediatric liver transplant recipients.
Main Methods:
- Retrospective analysis of the first 100 consecutive pediatric liver transplant patients from a total of 515 transplants.
- Data collection included patient demographics, liver disease etiology, transplant type, surgical techniques, complications, and outcomes.
- Follow-up duration ranged from 6 to 66.1 months.
Main Results:
- The study included 100 children (mean age 4.7 years) undergoing 103 liver transplants, with biliary atresia and progressive familial intrahepatic cholestasis as primary indications.
- Living-donor liver transplants constituted 88.4% of cases, with infection being the most common complication (34%).
- One-, 3-, and 5-year patient survival rates were 89.8%, 89.8%, and 83.8%, respectively, with no serious complications reported in living donors.
Conclusions:
- Living-donor liver transplantation is a safe and viable alternative for pediatric patients with end-stage liver disease.
- LDLT is increasingly becoming the preferred treatment option in centers facing a shortage of pediatric deceased-donor organs.
- The study highlights the success of LDLT in improving survival outcomes for children with liver failure.
Objectives:
Here, we present the outcomes of 100 consecutive pediatric liver transplant patients in our center.
Materials And Methods:
Five hundred fifteen adult and pediatric liver transplants were performed at Organ Transplantation Center, Sisli Memorial Hospital, Istanbul, Turkey, between August 2006 and November 2012. Of these, the first 100 consecutive pediatric liver transplant patients were retrospectively analyzed.
Results:
One hundred three liver transplants were performed in 100 children (mean age, 4.7 y; age range, 4.4 mo to 17.3 y; 53% female, 47% male; mean body weight, 17.2 kg; range, 4.5 to 75 kg). Biliary atresia (27%) and progressive familial intrahepatic cholestasis (18%) were the most common causes of liver disease. Of all the cases, 88.4% were living-donor liver transplants. Arterial reconstruction was performed under an operating microscope in most cases. Duct-to-duct biliary anastomoses were preferred in anatomically favorable cases. Mean hospital stay was 17.5 days. Median follow-up was 19.9 months (range, 6 to 66.1 mo). The main complication after surgery was infection (34%). Postoperative technical complications included hepatic arterial thrombosis (3.9%), portal venous thrombosis (6.8%), and biliary leak (6.8%). One-, 3-, and 5-year patient survivals were 89.8%, 89.8%, and 83.8%. There were no serious postoperative complications in the living donors.
Conclusions:
Living-donor liver transplant in pediatric patients is a safe alternative to deceased-donor transplant. It is becoming the most frequent treatment option for end-stage liver disease in pediatric patients in our center, given the paucity of pediatric deceased-donor organs.
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