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Liver transplantation in children: experience with the development of an Australian pilot programme. The Queensland
Insights
Paediatric liver transplantation (LTP) offers improved survival for children with end-stage liver disease. This Brisbane program has successfully performed six LTPs, with four children showing positive outcomes post-transplant.
Area of Science:
- Pediatric Gastroenterology and Hepatology
- Transplant Surgery
- Organ Transplantation
Background:
- End-stage liver disease (ESLD) in children is a significant indication for liver transplantation (LTP).
- Paediatric LTP programs demonstrate better survival rates compared to adults.
- Established international collaborations facilitate program development.
Purpose of the Study:
- To report the development and initial outcomes of a paediatric liver transplantation programme in Brisbane.
- To assess the feasibility and success of LTP for children with ESLD in a new centre.
Main Methods:
- Formal assessment of 14 children with ESLD for LTP suitability.
- Informed consent discussions with parents regarding LTP options.
- Establishment of a donor procurement team and logistical support.
- Performance of six orthotopic liver transplants (OLT) across two centers.
Main Results:
- Four out of six transplanted children are alive and well, with three demonstrating normal liver function.
- Two transplant recipients experienced graft failure and mortality.
- Three children died awaiting a suitable donor, and one remains on the waiting list.
- Follow-up ranged from 1 to 20 months.
Conclusions:
- Paediatric liver transplantation is a viable option for children with end-stage liver disease.
- Successful implementation requires robust international collaboration and dedicated logistical support.
- Ongoing challenges include donor availability and post-transplant complications such as rejection and sepsis.
Abstract:
Children with end-stage liver disease now form a major sub-group of patients considered suitable for liver transplantation (ltp), and enjoy better survival statistics after transplantation than do adults. Since June 1984, a paediatric ltp programme has been developed in Brisbane with an initial working relationship and ongoing close links with two USA centres (Pittsburgh, and the UCLA Medical Center). Fourteen children with end-stage liver disease have been referred to the Queensland Liver Transplantation Programme for formal assessment. Following frank, informed discussion with their parents, 10 of these children were offered the option of ltp. During the transition stage, two infants with biliary atresia were referred to UCLA at their parents' request and, subsequently, eight children aged from 9 months to 6 years have been placed on a transplant candidacy list in Brisbane. A donor procurement team with access to a Queensland Government jet has been available to cover all mainland States except Western Australia. Six of the children have now had orthotopic ltp (two children at the UCLA Medical Center; four children at the Royal Children's Hospital, Brisbane). One UCLA patient died with a non-functioning graft, and one Brisbane patient died 5 weeks post-transplant with rejection, hepatic artery thrombosis and sepsis. The other four children are alive and well, three with normal liver function and one with unexplained intrahepatic cholestasis, during the 1-20 month follow-up to date. Three further children have died of their liver disease without a donor of an appropriate blood group and size being found, and one patient still awaits a suitable donor.(ABSTRACT TRUNCATED AT 250 WORDS)