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Pediatric Liver Transplantation: A Single-Center Retrospective Study
Xiaohu Zhou1,2,3,4,5,6, Hanqi Yu1,2,3,4,5,6, Qiang Sun1,2,3,4,5,6
1Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Insights
Pediatric liver transplantation (LT) in China shows high survival rates, comparable to global standards. This study details outcomes at our center, highlighting advancements in living donor and split liver techniques for end-stage liver disease.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplantation Immunology
Background:
- Liver transplantation (LT) offers life-saving treatment for pediatric end-stage liver disease.
- Significant advancements in pediatric LT have been observed in mainland China.
- This study describes the current status of pediatric LT at our center.
Purpose of the Study:
- To report the outcomes of pediatric liver transplantation at our center.
- To analyze recipient and donor characteristics, surgical procedures, and complications.
- To evaluate survival rates and identify factors influencing mortality.
Main Methods:
- A retrospective review of 116 pediatric LT recipients from July 2019 to July 2023.
- Analysis of recipient/donor demographics, preoperative data, intraoperative details, and post-transplant complications.
- Kaplan-Meier survival analysis with log-rank testing.
Main Results:
- 116 pediatric LTs performed: 57 living donor (LDLT), 57 split liver (SLT), 2 whole liver (WLT).
- 1- and 3-year overall survival rates were 93.1% and 92.2%, respectively.
- Vascular (6.03%) and biliary (2.59%) complications were noted; mortality causes included infection and PTLD.
Conclusions:
- Pediatric LT in China demonstrates substantial progress with outcomes comparable to international standards.
- Split liver transplantation from deceased brain death donors showed survival rates similar to LDLT.
- Further research into postoperative management and immunosuppression strategies is needed to enhance survival.
Background:
Liver transplantation (LT) is a life-saving treatment for pediatric patients suffering end-stage liver disease, with the potential to yield positive long-term outcomes. Recently, remarkable progress has been achieved in mainland China. The purpose of this research is to describe the status in our center.
Method:
116 recipients from July 2019 to July 2023 were included in our study. The characteristics of recipients and donors, preoperative assessments, intraoperative details and posttransplant complications were described. The Kaplan-Meier method was applied to analyze the overall survival curves and was examined with the log-rank test.
Result:
A total of 116 pediatric LTs were performed, including 57 (49.1%) living donor liver transplantation (LDLT), 57 (49.1%) split liver transplantation (SLT) and 2 (1.8%) whole liver transplantation (WLT). The 1- and 3-year overall survival rates were 93.1% and 92.2%. The survival of DDLT was comparable to that of LDLT in our center (89.4% vs. 96.3% for 3-year survival rate). After LT, 7 (6.03%) vascular complications and 3 (2.59%) biliary complications were observed. The primary causes of mortality were drug-resistant bacteria infection and post-transplant lymphoproliferative disorder (PTLD).
Conclusion:
Pediatric LT has achieved tremendous progress in mainland China. The survival rate of our center was comparable to the published results worldwide. The survival rate of SLT from DBD donors was comparable to LDLT. Further research on the postoperative management and attempts of ISW will be required to improve survival.
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