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Published on: November 7, 2020
Survival and Complication of Liver Transplantation in Infants: A Systematic Review and Meta-Analysis
Yifu Hou1,2, Xiaoxiao Wang1,2, Hongji Yang1,2
1Department of Organ Transplantation, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Insights
Liver transplantation in infants shows moderate survival rates but carries a high risk of infection and sepsis. Further research with larger cohorts and longer follow-up is needed to improve outcomes for pediatric liver transplant patients.
Area of Science:
- Pediatric Surgery
- Hepatology
- Transplantation Medicine
Background:
- Infant liver transplantation (LT) is increasingly feasible due to surgical advances.
- Limited data exists on the long-term outcomes of LT in this pediatric population.
- This study addresses the need for comprehensive outcome data in infant LT.
Approach:
- A systematic meta-analysis was conducted using PubMed, Scopus, and Google Scholar.
- Included studies focused on retrospective records or cohort approaches reporting infant LT outcomes.
- Statistical analysis was performed using STATA version 13.0 on data from 22 studies.
Key Points:
- Pooled patient survival rates at 1 year, 1-5 years, and >5 years were 85%, 71%, and 80%, respectively.
- Pooled graft survival rates at 1 year, 1-5 years, and >5 years were 72%, 62%, and 71%, respectively.
- High complication rates were observed: vascular (12%), re-transplantation (16%), biliary (15%), and infection/sepsis (50%).
Conclusions:
- Infant liver transplantation demonstrates modest patient and graft survival rates.
- Infection and sepsis represent significant, high-frequency complications post-transplantation.
- Larger studies with extended follow-up are crucial for enhancing infant LT evidence and care.
Abstract:
Background: Modern surgical techniques and scientific advancements have made liver transplant (LT) in infants feasible. However, there are only a small number of studies examining the short- as well as long-term outcomes of LT in this vulnerable subset of children. Methods: Comprehensive searches were done systematically through the PubMed, Scopus, and Google scholar databases. Studies that were retrospective record based or adopted a cohort approach and reported either patient survival rates or graft survival rates or complications of LT in infants were included in the meta-analysis. Statistical analysis was done using STATA version 13.0. Results: A total of 22 studies were included in the meta-analysis. The overall pooled patient survival rate at 1 year, >1-5 years, and >5 years post-transplantation was 85% (95% CI: 78--92%), 71% (95% CI: 59-83%), and 80% (95% CI: 69-91%), respectively. The overall pooled graft survival rate at 1 year, >1-5 years, and >5 years post-transplantation was 72% (95% CI: 68-76%), 62% (95% CI: 46-78%), and 71% (95% CI: 56-86%), respectively. The overall pooled rate for vascular complications, need for re-transplantation, biliary complications, and infection/sepsis was 12% (95% CI: 10-15%), 16% (95% CI: 12-20%), 15% (95% CI: 9-21%), and 50% (95% CI: 38-61%), respectively. Conclusion: The current meta-analysis showed modest patient and graft survival rates for infant liver transplantation. However, the complication rates related to infection/sepsis were high. More comprehensive evidence is required from studies with larger sample sizes and a longer duration of follow-up.
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