Related Experiment Videos
Lessons from the first 100 liver transplantations in children at Bicêtre Hospital
T Yandza1, F Gauthier, J Valayer
1Department of Pediatric Surgery, Hôpital Bicêtre, Kremlin Bicêtre, France.
Insights
Pediatric liver transplantation outcomes show an 86% survival rate at 4 years, with aggressive reintervention improving results. ABO-incompatible grafts may be better tolerated in children without pre-existing ABO antibodies.
Area of Science:
- Pediatric Surgery
- Transplantation Immunology
- Hepatology
Background:
- Liver transplantation in children presents unique challenges.
- Reduced-size grafts and specific immunosuppression protocols are employed.
- Surgical complications and graft survival are key concerns.
Purpose of the Study:
- To report the experience with 100 pediatric liver transplantations.
- To analyze surgical complications and survival rates.
- To evaluate the impact of ABO compatibility and reintervention strategies.
Main Methods:
- Retrospective analysis of 100 liver transplantations in 85 children (1988-1991).
- Use of reduced-size grafts in 54% of cases.
- Immunosuppression with cyclosporine, steroids, and azathioprine.
Main Results:
- Actuarial survival rate at 4 years was 86%.
- Frequent complications included biliary issues (17%), hepatic artery thrombosis (14%), and hemoperitoneum (14%).
- ABO-incompatible grafts showed similar survival rates, potentially better tolerated in antibody-negative recipients.
Conclusions:
- An aggressive reintervention policy, including retransplantation, is crucial for optimal outcomes.
- Early surgical revision for thrombotic complications can avoid retransplantation in 50% of cases.
- Children without pre-transplant ABO alloantibodies may better tolerate ABO-incompatible liver grafts.
Abstract:
The authors report their experience with 100 liver transplantations at Bicêtre Hospital. From 1988 to 1991, 85 children received a total of 100 liver grafts (mean age, 44.4 months; two thirds were under 3 years of age). Fifty-four percent of the grafts were reduced-size. Cyclosporine, steroids, and azathioprine were used for immunosuppression. The actuarial survival rate at 4 years is 86%. Retransplantation was performed in 14 children (16%). Forty-four patients (49%) had another operation. Biliary complications (17%), hepatic artery thrombosis (HAT) (14%), and hemoperitoneum (14%) were the most frequent surgical complications. Retransplantation was avoided in 50% of the patients who underwent urgent artery revision for thrombotic complications. It appeared that ABO-incompatible were better tolerated in children without ABO alloantibodies at the time of transplantation. The survival rates of ABO-identical, -compatible, and -incompatible liver grafts did not differ (61%, 50%, and 57% respectively). The results suggest that an aggressive policy of reintervention, including retransplantation, is necessary to achieve a satisfactory survival rate and quality of life. Children lacking ABO alloantibodies at the time of transplantation might tolerate ABO-incompatible liver grafts better.