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Paediatric liver transplantation in Australia and New Zealand: 1985-2018
Michael O Stormon1, Winita Hardikar2, Helen M Evans3
1Department of Gastroenterology, Children's Hospital Westmead, Sydney, New South Wales, Australia.
Insights
Pediatric liver transplantation in Australia and New Zealand has evolved significantly, offering excellent outcomes. Current 10-year survival rates for pediatric liver transplant recipients reach 95%.
Area of Science:
- Pediatric Hepatology
- Transplant Surgery
- Immunology
Background:
- Liver transplantation is the standard treatment for end-stage liver disease in children.
- Significant advancements in medical and surgical care have occurred over 30 years.
- Four major pediatric liver transplant centers operate in Australia and New Zealand.
Purpose of the Study:
- To review trends and outcomes of pediatric liver transplantation in Australia and New Zealand.
- To analyze changes in transplant indications and innovations over three decades.
- To assess the effectiveness of current pediatric liver transplant protocols.
Main Methods:
- Retrospective analysis of 977 pediatric liver transplant cases (1985-2018).
- Data sourced from the Australia and New Zealand Liver Transplant Registry.
- Review of indications, surgical techniques, immunosuppression, and outcomes.
Main Results:
- Biliary atresia remains the most common indication (54%), with increasing rates for metabolic disorders, liver failure, and tumors.
- Innovations include split grafts, live donation, improved immunosuppression, and surgical techniques for infants.
- Current 10-year patient survival rates are excellent at 95%.
Conclusions:
- Pediatric liver transplantation in ANZ has demonstrated remarkable progress and excellent patient survival.
- Continuous innovation in techniques and protocols enhances outcomes for pediatric liver transplant recipients.
- The region's transplant programs are comparable to leading international centers.
Abstract:
Liver transplantation has become the standard of care for children with end-stage liver disease. In Australia and New Zealand, there are four paediatric liver transplant units, in Sydney, Melbourne, Brisbane and Auckland. Over the past 30 years, there have been significant changes to indications for transplant, as well as medical and surgical advances. In this paper, using retrospective data from the Australia and New Zealand Liver Transplant Registry, we review 977 children (less than 16 years of age) who underwent liver transplant from 1985 to 2018. The most common indication was biliary atresia (54%), although there has been an increase in other indications, including inborn errors of metabolism, fulminant hepatic failure and malignant liver tumours. Over the past 3 decades, areas of change and innovation include: the use of 'split grafts' to enable an adult and a child to receive the same donor liver, live donation, improvements in immunosuppressive regimens and infectious prophylaxis protocols and innovative surgical techniques allowing transplantation in smaller infants. The outcomes for children who undergo liver transplant in ANZ are excellent, with current 10-year patient survival rates of 95%, comparable to other larger centres around the world.
