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Paediatric Living Donor Liver Transplantation: ASingle Centre Experience from Pakistan
Abu Bakar Hafeez Bhatti1, Faisal Saud Dar1, Syeda Shaheera Hashmi2
1Department of HPB and Liver Transplantation, Shifa International Hospital, Karachi.
Insights
Paediatric living donor liver transplantation (LDLT) in Pakistan showed 90-day morbidity of 71.4% and mortality of 14.2%, primarily due to pulmonary infections. Despite complications, 3-year survival reached 85%.
Area of Science:
- Hepatology
- Transplantation Surgery
- Pediatric Gastroenterology
Background:
- Liver transplantation is a critical treatment for pediatric liver failure.
- Living donor liver transplantation (LDLT) expands donor options, particularly in regions with organ shortages.
- Outcomes of pediatric LDLT in Pakistan require specific evaluation due to unique healthcare contexts.
Purpose of the Study:
- To assess the 90-day morbidity and mortality rates in pediatric liver transplant recipients in Pakistan.
- To identify common causes of morbidity and mortality following pediatric LDLT.
- To evaluate the overall survival rates in this patient cohort.
Main Methods:
- A cohort study was conducted at Shifa International Hospital, Islamabad, Pakistan, from April 2012 to April 2015.
- Included were pediatric patients (≤17 years) undergoing LDLT with a minimum 3-month follow-up.
- Morbidity was defined as Clavien-Dindo grade 2 or higher complications; 90-day outcomes were the primary focus.
Main Results:
- Fourteen pediatric LDLTs were performed, with recipients aged 6 months to 17 years.
- The most frequent indications were Wilson's disease and cryptogenic cirrhosis (28.6% each); 35.7% had acute liver failure.
- Overall 90-day morbidity was 71.4% and mortality was 14.2%, with pulmonary infections being the cause for both. Three-year survival was estimated at 85%.
Conclusions:
- Pediatric LDLT is a viable and promising therapeutic option for children suffering from acute and chronic liver failure.
- Post-transplant pulmonary infections represent a significant cause of mortality in pediatric LDLT recipients.
- Further research into infection prevention and management strategies is crucial to improve outcomes.
Objective:
To determine the outcomes of paediatric living donor liver transplantation (LDLT) recipients from Pakistan in terms of 90-day morbidity and mortality.
Study Design:
Cohort study.
Place And Duration Of Study:
Shifa International Hospital, Islamabad, Pakistan, between April 2012 and April 2015.
Methodology:
All patients in paediatric age group (≤ 17 years) who underwent LDLT with a minimum follow-up of 3 months, were included. All grade 2 and above complications on Clavien-Dindo system were included as morbidity. The main outcome measure was 90-day morbidity and mortality.
Results:
Fourteen paediatric LDLTs were performed. Median age of the recipients was 8.5 years ranging between 6 months and 17 years. Wilson's disease and cryptogenic cirrhosis were the most common etiologies (28.6% each). Acute liver failure was present in 5 (35.7%) patients. Overall 90-day morbidity and mortality was 71.4% and 14.2%; both were attributable to pulmonary infection. No difference was observed in morbidity (21.3% vs. 42.8%, p=0.3) and mortality rates (20% vs. 11%, p=1.0) between patients with acute and chronic liver failure. Estimated 3-year survival was 85%.
Conclusion:
Paediatric LDLT offers a promising treatment option for acute and chronic liver failure. Mortality was attributable to post-transplant pulmonary infections.