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Our first 100 consecutive pediatric liver transplants
J Vazquez1, M L Santamaria, J Murcia
1Department of Pediatric Surgery, Hospital Infantil La Paz, Madrid, Spain.
Insights
Pediatric orthotopic liver transplantation (OLT) is a successful treatment for end-stage liver disease, with a 5-year survival rate of 75% in children, even for those under 20 kg. This study analyzes 100 OLTs in children, highlighting indications and outcomes.
Area of Science:
- Pediatric Surgery
- Hepatology
- Transplantation Immunology
Background:
- Orthotopic liver transplantation (OLT) is the primary treatment for end-stage liver disease.
- Pediatric OLT presents unique challenges compared to adult transplantation.
- The efficacy of dedicated pediatric OLT programs requires ongoing evaluation.
Purpose of the Study:
- To analyze the outcomes of the first 100 consecutive pediatric orthotopic liver transplantations (OLTs) at a single center.
- To assess the feasibility and results of OLT in children, particularly those with low body weight.
- To identify indications, complications, and survival rates in pediatric liver recipients.
Main Methods:
- Retrospective analysis of 100 OLTs performed in 78 pediatric patients between 1986 and the study period.
- Evaluation of patient demographics, indications for transplantation, graft types, retransplantation rates, and complications.
- Assessment of acute and chronic rejection episodes and their management, alongside surgical complications and survival data.
Main Results:
- 100 OLTs were performed in 78 children, with 61% weighing less than 20 kg.
- Common indications included cholestasis (45%), metabolic disease (18%), and cirrhosis (10%).
- Five-year actuarial survival rate was 75%, with significant rates of acute rejection (52%) and surgical complications like hepatic artery thrombosis (12%) and biliary issues (13%).
Conclusions:
- Pediatric OLT is a viable and effective treatment for end-stage liver disease in children, even in low-weight recipients.
- Careful management of rejection and surgical complications is crucial for improving long-term outcomes.
- Dedicated pediatric liver transplant programs can achieve favorable survival rates, supporting their continued necessity.
Abstract:
Orthotopic liver transplantation (OLT) is nowadays accepted as the best therapy for end-stage liver disease. The difficulties involved are even greater in children than in adults, and it is debatable whether exclusively pediatric programs are warranted. The aim of this paper is to analyze our experience at the Children's Hospital "La Paz", with the first consecutive 100 OLT in children, 61% of whom weighed less than 20 kg. Since 1986, 220 pediatric patients were evaluated as candidates, 100 OLT were performed in 78 patients and 13 died on the waiting list, currently maintained below 15 cases. Indications were: cholestasis (45), metabolic disease (18), fulminant hepatic failure (3), primary liver tumors (2) and cirrhosis (10). Mean age was 66 months (range = 7 to 216) with a mean weight of 21 kg (range = 6 to 60), twenty patients weighed less than 13 kilograms. OLT was performed by standard technique. Reduced or segmental grafts were necessary in 8 instances. Twenty-two patients were retransplanted and 2 received three grafts. Indications for retransplantation were: hepatic artery thrombosis (8), primary nonfunction (4), chronic rejection (7), portal thrombosis (2) and Budd-Chiari recurrence (1). Acute rejection was observed in 52 patients, and eight cases developed a chronic rejection. These episodes were treated with "bolus" of steroids, monoclonal antibodies (OKT-3) and FK-506. Surgical complications included: hepatic artery thrombosis 12%, portal vein thrombosis 3% and biliary fistula or stenosis 13%. The incidence of primary non-function was 7%. Actuarial survival rate at 5 years was 75%.(ABSTRACT TRUNCATED AT 250 WORDS)