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Pretransplant mortality in children awaiting living donor liver transplantation: a prospective center-based study

Tri Hening Rahayatri1,2, Ni Made Sarastri Widyani3, Hanifah Oswari2,4

  • 1Pediatric Surgery, Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo, Central Jakarta, Indonesia.

World Journal of Pediatric Surgery
|March 16, 2026
PubMed

Insights

Children awaiting pediatric liver transplants face high mortality, mainly from sepsis and malnutrition. Donor scarcity prolongs waiting times, increasing risks for pediatric liver transplantation candidates in Indonesia.

Area of Science:

  • Pediatric Hepatology
  • Transplant Surgery
  • Public Health

Background:

  • High mortality rates among children awaiting liver transplantation are a global concern.
  • Indonesia's sole pediatric living-donor liver transplantation (LDLT) center faces similar challenges.
  • Understanding waiting list mortality is crucial for improving outcomes.

Purpose of the Study:

  • To determine the mortality rate in children listed for LDLT.
  • To analyze the time to death or transplantation.
  • To identify the primary causes of death in pediatric LDLT candidates.

Main Methods:

  • Prospective single-center cohort study from January 2023 to December 2024.
  • Inclusion of all eligible children (age 0-18) listed for LDLT.
  • Monitoring from listing until death, transplantation, loss to follow-up, or study end.

Main Results:

  • 62 children were enrolled; 72.58% had biliary atresia.
  • 70.97% experienced malnutrition; 35.48% had prior cytomegalovirus (CMV) infection.
  • Median time to death was 87.5 days; 22 deaths occurred, primarily due to sepsis.

Conclusions:

  • Pediatric liver transplant candidates face significant waiting list mortality.
  • Infection, malnutrition, and socioeconomic factors are key contributors.
  • Sepsis remains the leading cause of death, highlighting the need for improved management and donor availability.
Abstract

Keywords:
MortalityPediatrics

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