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100 consecutive liver transplants in infants and children: an 8-year experience
D E Eckhoff1, A M D'Alessandro, S J Knechtle
1Department of Surgery, University of Wisconsin School of Medicine, Madison.
Insights
Pediatric liver transplantation offers a promising survival rate, with an 8-year actuarial survival of 77.3% for infants and children. Reduced-size liver transplants (RLT) showed similar outcomes to whole-size liver transplants (WLT).
Area of Science:
- Pediatric Surgery
- Hepatology
- Transplantation Immunology
Background:
- End-stage liver disease in infants and children necessitates liver transplantation.
- Orthotopic liver transplantation is the established treatment of choice for pediatric end-stage liver disease.
Purpose of the Study:
- To evaluate the outcomes of 100 consecutive pediatric liver transplants.
- To analyze patient survival rates and complication incidence in pediatric liver transplant recipients.
Main Methods:
- Retrospective analysis of 100 liver transplants in 76 pediatric patients over an 8-year period.
- Comparison of outcomes between reduced-size liver transplants (RLT) and whole-size liver transplants (WLT).
Main Results:
- Overall 8-year actuarial patient survival rate was 77.3%.
- Biliary atresia patients had an 8-year survival rate of 82.3%.
- No significant difference in survival was observed between RLT and WLT.
Conclusions:
- Pediatric liver transplantation demonstrates favorable long-term survival rates.
- Common complications include rejection episodes, infections, and biliary issues, necessitating reoperations.
- Reduced-size and whole-size liver transplants yield comparable survival outcomes in pediatric patients.
Abstract:
Orthotopic liver transplantation has become the treatment of choice for most children and infants with end-stage liver disease. The purpose of this retrospective study was to examine the results of 100 consecutive liver transplants performed in infants and children at a single institution. During an 8-year study period (July 1984 to December 1992), 100 pediatric liver transplants were performed in 76 patients. Thirty-four patients (44.7%) were infants (mean age, 7.0 months; mean weight, 6.1 kg), and 42 (55.3%) were children (mean age, 8.2 years; mean weight, 30.6 kg). There were 36 reduced-size liver transplants (RLT) and 64 whole-size transplants (WLT). Eight infants (23.5%) and 10 children (20.7%) required retransplantation. After transplantation, 71% of the patients had one or more rejection episodes, 66% had one or more infections, 17.1% had biliary complications, and 39.4% required one or more reoperations. There were 17 deaths. The actuarial 8-year survival rate for the patients with biliary atresia was 82.3%; for all infants in this series, it was 77.6%. No difference in patient survival was noted when RLT was compared with WLT. The overall 8-year actuarial patient survival rate for infants and children was 77.3%.