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Long-term Prognosis in Pediatric Living Donor Liver Transplant Recipients Who Have Survived the First Year of Surgery
Vipul Gautam1, Phani K Nekarakanti2, Vikram Kumar1
1Department of Pediatric Hepatology, Centre for Liver and Biliary Sciences, Max Super Speciality Hospital, Saket, New Delhi, India.
Insights
Pediatric living donor liver transplants (LDLT) show promising long-term survival rates, particularly in one-year survivors. Socioeconomic factors impact adherence, but online follow-ups aid care in developing nations.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplant Medicine
Background:
- Long-term outcomes of pediatric living donor liver transplant (LDLT) are critical for informed consent.
- This study examines pre-transplant clinical factors, surgical aspects, complications, follow-up, and prognosis in a developing country's LDLT program.
Purpose of the Study:
- To evaluate long-term outcomes and prognostic factors in pediatric living donor liver transplant recipients.
- To assess the impact of socioeconomic factors and follow-up strategies on transplant success.
Main Methods:
- Retrospective analysis of a prospectively maintained database (September 2006 - January 2023) of pediatric liver transplant (pLT) recipients surviving over one year.
- Cohort included 358 compliant patients and 90 noncompliant patients, with analysis of clinical parameters, interventions, and survival rates.
Main Results:
- 448 out of 480 pLTs (93.3%) survived beyond one year; 358 formed the main cohort.
- Survival probabilities at 3, 5, 10, and 15 years were 95%, 93%, 91%, and 72.4%, respectively.
- Pediatric end-stage liver disease (PELD) score and post-transplant portal vein thrombosis (PVT) were independent prognostic factors for survival.
Conclusions:
- Pediatric LDLT offers favorable long-term outcomes in one-year survivors.
- Online follow-up consultations are effective in developing countries.
- Pre-LT PELD score and post-LT PVT are key indicators for risk assessment and care optimization.
Background:
Understanding long-term pediatric living donor liver transplant (LDLT) outcomes is crucial for families when consenting to it. This study focussed on pre-liver transplant (LT) clinical parameters, surgical procedures, delayed complications, follow-up challenges, and long-term prognosis within a living-donor program in a developing country.
Methods:
This single-center retrospective study was carried out using a prospectively maintained database spanning from September 2006 to January 2023. The study included all pediatric LT (pLT) recipients, aged 1 month to 17 years, who survived for more than a year following LT.
Results:
During the study, 480 pLTs were performed, with 448 (93.3%) children surviving beyond one year. Of 448 pLT recipients, 358 with adequate follow-up data formed the study cohort for long-term outcomes, while 90 with poor medication adherence and/or insufficient follow-up were analyzed separately as a noncompliant group. The majority (232,65%) of patients supplemented physical outpatient visits with online follow-up consultations via email and other online platforms. Twenty-three percent necessitated intervention within three-months of the surgery; however, it had no impact on occurrence of late complications or overall survival (P = 0.398). The primary cause of noncompliance was socioeconomic factors, which contributed to an increased incidence of chronic rejection in this group (12/90, 13.3%). Out of 358 compliant children, 30 died and 23 survived following late radiological or surgical intervention, while the remaining 305 had an uneventful long-term course with a median follow-up of 62 (IQR:31-112) months. The life table showed survival probabilities of 95%, 93%, 91%, and 72.4% at 3, 5, 10, and 15 years, respectively. Pediatric end-stage liver disease (PELD) score and post-LT portal vein thrombosis (PVT) were independent prognostic factors for long-term survival.
Conclusion:
Pediatric LDLT yields favorable long-term outcomes, especially in 1-year survivors. Online follow-ups are beneficial in developing countries. Pre-LT PELD score and post-LT PVT help assess risk and optimize care.
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