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Orthotopic liver transplantation in children: two-year experience with 47 patients
Insights
Pediatric liver transplantation using cyclosporine and prednisone is effective for end-stage liver disease. Survivors show improved health and growth, with most complications occurring early post-transplant.
Area of Science:
- Pediatric Surgery
- Immunosuppression Therapy
- Organ Transplantation
Background:
- End-stage liver disease in children presents significant challenges.
- Biliary atresia/hypoplasia and metabolic liver diseases are primary indications for pediatric liver transplantation.
- High mortality rates exist for pediatric patients awaiting liver transplantation.
Purpose of the Study:
- To evaluate the efficacy and outcomes of orthotopic liver transplantation in pediatric patients.
- To assess the impact of immunosuppression with cyclosporine and prednisone on transplant success.
- To analyze complications and survival rates in young liver transplant recipients.
Main Methods:
- A cohort of 47 pediatric patients (7 months to 18 years) underwent orthotopic liver transplantation.
- Immunosuppression was managed with cyclosporine and prednisone.
- Patient outcomes, including survival, complications, and clinical status, were monitored over a 24-month period.
Main Results:
- Thirty out of 47 patients survived, with follow-up ranging from 6 to 29 months.
- Twenty-one of 32 patients were alive at 1 year post-initial transplantation.
- Survivors experienced relief from chronic liver disease symptoms, with many showing catch-up growth; early complications and deaths were noted.
Conclusions:
- Orthotopic liver transplantation is an effective treatment for pediatric end-stage liver disease.
- Early post-transplant complications and rejection episodes are critical factors influencing outcomes.
- Successful liver transplantation offers significant long-term benefits for pediatric patients, including improved quality of life and growth.
Abstract:
During a 24-month period (May 1981 to May 1983), 47 pediatric patients (ranging in age from 7 months to 18 years) underwent orthotopic liver transplantation using cyclosporine and prednisone. Major indications were biliary atresia/hypoplasia, and metabolic liver disease. Thirty-two of 138 patients evaluated for the procedure died prior to transplantation. Thirty patients are alive from 6 to 29 months later including 7/15 patients who required retransplantation. Twenty-one of 32 patients are alive at 1 year following initial transplantation. All 30 survivors are clinically well and living at home; only one has an abnormal bilirubin level. Serious, life-threatening medical and surgical complications were common during the early months following transplantation. With one exception, deaths and major rejection episodes occurred early (before 120 days). All survivors are relieved of the stigmata of chronic liver disease, and many have demonstrated catch-up growth. Liver transplantation is an effective treatment for end-stage pediatric liver disease.