Liver transplantation in children: the initial Toronto experience

Area of Science:

• Pediatric Surgery
• Hepatology
• Transplantation Medicine

Background:

• Pediatric liver transplantation is a complex procedure with varying outcomes.
• Risk stratification is crucial for predicting success in pediatric liver transplant recipients.
• The Hospital for Sick Children reviewed its initial 2-year experience to assess outcomes.

Purpose of the Study:

• To review the initial 2-year experience with pediatric liver transplantation at The Hospital for Sick Children.
• To evaluate survival rates based on a defined high-risk and low-risk patient stratification.
• To identify early and late causes of mortality and complications.

Main Methods:

• Patients were categorized into high-risk (under 10 kg, extrahepatic biliary atresia, portal vein atresia/thrombosis, hepatic coma) and low-risk groups.
• A retrospective review of 29 assessed patients, including 18 transplanted individuals.
• Analysis of survival data, causes of death, and transplant-related complications.

Main Results:

• Eighteen patients underwent 23 liver transplants; 6 patients died on the waiting list.
• High-risk group survival was 55% (7/13), significantly lower than the low-risk group's 80% (P < 0.05).
• Early deaths were linked to ischemia, thrombosis, and brain death; late deaths to CMV, rejection, and myocardial infarction. Primary nonfunction was 4.3%, arterial thrombosis 13%.

Conclusions:

• Risk stratification effectively predicts survival in pediatric liver transplantation.
• Extrahepatic biliary atresia (EHBA) patients had a 67% survival rate, better than the overall high-risk group but lower than the low-risk group.
• Complications such as ischemia, thrombosis, rejection, and infections significantly impact outcomes in this pediatric cohort.