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Liver transplantation before 1 year of age
Insights
Pediatric liver transplantation in infants shows a 60% survival rate, with excellent graft function in survivors. Improving outcomes requires addressing primary nonfunction, sepsis, and donor availability.
Area of Science:
- Pediatric surgery
- Transplant immunology
Background:
- Orthotopic liver transplantation (OLT) in infants is a complex procedure with significant challenges.
- Immunosuppression protocols are critical for graft survival in pediatric recipients.
Purpose of the Study:
- To evaluate the outcomes of OLT in infants younger than 1 year.
- To identify factors influencing survival and morbidity in this patient population.
Main Methods:
- Retrospective analysis of 20 infant OLT recipients between 1981 and the present.
- Immunosuppression regimen included cyclosporine and corticosteroids.
- Follow-up duration ranged from 1 to 56 months.
Main Results:
- A 60% survival rate was observed in 20 infant recipients.
- Major causes of mortality included primary allograft nonfunction and sepsis.
- Hepatic artery thrombosis, gastrointestinal and biliary complications, and infections were significant morbidities.
Conclusions:
- Pediatric OLT in infants can achieve acceptable survival rates with good allograft function.
- Strategies to prevent hepatic artery thrombosis, reduce sepsis, and improve donor organ matching are crucial for enhancing outcomes.
- Retransplantation offers a survival option for some infants with graft failure.
Abstract:
Since 1981, 20 infants younger than 1 year of age received 26 orthotopic liver transplants. Immunosuppression was with cyclosporine and corticosteroids. Thirteen (65%) of the recipients were discharged from the hospital. To date, 12 (60%) of the 20 recipients are surviving, with follow-up of 1 to 56 months (average 14 months). The 5-year actuarial survival is 53.8%. The allograft liver function in the majority of surviving infants is excellent. The predominant causes of mortality were primary nonfunction of the allograft (three patients) and sepsis (three). Major morbidity was caused by hepatic artery thrombosis (five patients), gastrointestinal complications (six), biliary tract complications (five), and bacterial and viral infections (13). Six patients underwent retransplantation; three of these six survived. Results could be improved by prevention of hepatic artery thrombosis, by decreasing the incidence of sepsis, and by procurement of more and better suited pediatric donors.