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Outcome of Pediatric Liver Transplants in Patients With Less Than 10 kg of Body Weight Is Not Worse
Yuktansh Pandey1, Sharat Varma, Bhargava Ram Chikkala
1From the Centre for Liver and Biliary Sciences, Max Super Speciality Hospital, Saket, New Delhi, India.
Insights
Pediatric liver transplant recipients under 10 kg show comparable or better survival rates than heavier children. Advanced surgical methods and vigilant postoperative care are key to successful outcomes in these young patients.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplant Medicine
Background:
- Liver transplantation in pediatric patients under 10 kg presents unique surgical challenges.
- Historically, a 10 kg body weight threshold has been associated with less favorable post-transplant outcomes.
- Evolving surgical techniques and management strategies offer potential to improve outcomes in this cohort.
Purpose of the Study:
- To compare liver transplant outcomes in pediatric patients weighing less than 10 kg versus those weighing more than 10 kg.
- To identify factors influencing outcomes in pediatric liver transplant recipients.
- To evaluate the impact of body weight on graft function and patient survival.
Main Methods:
- Retrospective analysis of 90 pediatric liver transplant recipients.
- Patients were divided into two groups: Group A (>10 kg, n=35) and Group B (<10 kg, n=55).
- Comparison of pre-transplant characteristics, graft parameters, and post-transplant outcomes including survival rates.
Main Results:
- Group B (<10 kg) had a higher Pediatric End-stage Liver Disease (PELD) score (24 vs 18) and graft-to-recipient weight ratio (2.8 vs 1.7).
- Patient survival rate was higher in Group B (86%) compared to Group A (77%).
- Portal vein thrombosis occurred exclusively in Group B, while biliary leaks were more frequent in Group B (5) than Group A (1).
Conclusions:
- Pediatric liver transplant recipients weighing less than 10 kg achieve similar or superior survival rates compared to heavier counterparts.
- Advancements in surgical techniques are crucial for improving outcomes in low-weight pediatric recipients.
- Close monitoring for complications and prompt intervention are vital for successful liver transplantation in this population.
Objectives:
Liver transplant in pediatric patients with body weight < 10 kg poses a challenge to the entire liver transplant team. Many reports have considered 10 kg to be a cutoff pointfor body weightforfavorable posttransplant outcomes. With evolving surgical techniques and postoperative management, there is potential to improve outcomes in this subset of recipients. We compared the outcomes in pediatric patients with body weight < 10 kg with those > 10 kg; also, we studied the factors of influence.
Materials And Methods:
We performed a retrospective analysis to evaluate the outcomes of liver transplants in pediatric patients with < 10 kg body weight. The cohort consisted of 90 children subdivided into the following 2 subgroups: group A (n = 35) with > 10 kg body weight at liver transplant and group B (n = 55) with < 10 kg body weight at liver transplant. We compared the following pretransplant characteristics between the groups: graft weight, graft-to-recipient weightratio, cold ischemia time, warm ischemia times, and liver transplant outcomes.
Results:
Pediatric End-stage Liver Disease score was significantly higher in group B (score of 24) versus group A (score of 18). Group B had significantly higher graft-to-recipient weight ratio (2.8 in group B vs 1.7 in group A). Graft function showed no significant difference between the 2 groups. Portal vein thrombosis was seen only in group B, whereas biliary leaks were observed among 5 patients in group B and 1 patientin group A. Patient survivalrate was higherin group B (86%) than in group A (77%).
Conclusions:
Pediatric patients weighing < 10 kg have similarif not better survivalrates after liver transplant compared with patients > 10 kg. Advancements in surgical techniques and a careful monitoring for complications and timely intervention are important to facilitate these outcomes.
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