Ten years of a pediatric living donor liver transplantation program in Brazil

Area of Science:

• Hepatology
• Pediatric Surgery
• Transplantation Medicine

Background:

• Pediatric living-donor liver transplantation (LDLT) offers a safe alternative for children with end-stage liver disease.
• Specialized centers and staff are crucial for optimizing long-term survival and quality of life in pediatric LDLT recipients.

Purpose of the Study:

• To evaluate the outcomes and the 10-year learning curve of a pediatric living-donor liver transplantation program.
• To assess the program's evolution and its impact on patient survival and complications.

Main Methods:

• A retrospective cohort study analyzed pediatric liver transplant recipients between 2013 and 2023.
• Outcomes and survival rates were compared between two distinct 5-year periods to identify trends and improvements.

Main Results:

• Transplant volume increased from 25 to 48 patients between the first and second 5-year periods.
• Portal vein thrombosis (15.1% vs 9.6%) and hepatic artery thrombosis (11% vs 7%) rates decreased in the second period.
• Warm ischemia time significantly decreased in the second period (32.6 vs 38.4 minutes, P=0.018), while patient survival rates remained high (84% vs 91.7% at 5 years, P=0.32).

Conclusions:

• The pediatric LDLT program demonstrates feasibility and consistent outcomes over a decade.
• Findings support the establishment of living donor programs with continuous improvement in surgical techniques and patient care.
• The study highlights the importance of specialized care in achieving favorable long-term results for pediatric liver transplant recipients.