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Current Status and Outcomes of Living Donor Liver Transplantation for Pediatric Acute Liver Failure: Results From a
Hajime Uchida1, Suk Kyun Hong2, Shinya Okumura3
1Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
Insights
Living donor liver transplantation for pediatric acute liver failure has improved outcomes in recent years. Early detection of rejection and careful management of sepsis are key to further enhancing patient and graft survival.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplantation Immunology
Background:
- Living donor liver transplantation (LDLT) for pediatric acute liver failure (PALF) outcomes have improved but remain lower than for chronic liver disease.
- Investigated if LDLT outcomes for PALF have improved in the contemporary era.
Purpose of the Study:
- To evaluate the trends and outcomes of LDLT for PALF over two decades.
- To compare patient and graft survival rates between two distinct transplant eras.
Main Methods:
- Analysis of 193 patients undergoing LDLT between December 2000 and December 2020.
- Comparison of outcomes between two eras: 2000-2010 (era 1) and 2011-2020 (era 2).
Main Results:
- Era 2 showed significantly lower patient and graft mortality rates compared to era 1 (p=0.03 and p=0.047).
- 1- and 5-year survival rates improved from 76.4% and 70.9% in era 1 to 88.3% and 81.9% in era 2 (p=0.042).
- Sepsis within 30 days post-LDLT was independently associated with graft loss (p=0.002).
Conclusions:
- Patient survival following LDLT for PALF has significantly improved in the contemporary era.
- Early detection and management of rejection, alongside vigilant sepsis monitoring, are crucial for improving long-term outcomes.
Background:
Although the outcomes of living donor liver transplantation (LDLT) for pediatric acute liver failure (PALF) have improved, patient survival remains lower than in patients with chronic liver disease. We investigated whether the poor outcomes of LDLT for PALF persisted in the contemporary transplant era.
Methods:
We analyzed 193 patients who underwent LDLT between December 2000 and December 2020. The outcomes of patients managed in 2000-2010 (era 1) and 2011-2020 (era 2) were compared.
Results:
The median age at the time of LDLT was 1.2 years both eras. An unknown etiology was the major cause in both groups. Patients in era 1 were more likely to have surgical complications, including hepatic artery and biliary complications (p = 0.001 and p = 0.013, respectively). The era had no impact on the infection rate after LDLT (cytomegalovirus, Epstein-Barr virus, and sepsis). The mortality rates of patients and grafts in era one were significantly higher (p = 0.03 and p = 0.047, respectively). The 1- and 5-year survival rates were 76.4% and 70.9%, respectively, in era 1, while they were 88.3% and 81.9% in era 2 (p = 0.042). Rejection was the most common cause of graft loss in both groups. In the multivariate analysis, sepsis during the 30 days after LDLT was independently associated with graft loss (p = 0.002).
Conclusions:
The survival of patients with PALF has improved in the contemporary transplant era. The early detection and proper management of rejection in patients, while being cautious of sepsis, should be recommended to improve outcomes further.
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