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Liver transplantation in small babies
J Vázquez1, M Gámez, M L Santamaría
1Department of Pediatric Surgery, Children's Hospital La Paz, Madrid, Spain.
Insights
Pediatric liver transplantation outcomes are improved for children under 13 kg, a high-risk group. This study evaluated their impact on transplant program results, showing a 64% survival rate.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplantation Immunology
Background:
- Pediatric liver transplantation offers significant survival benefits for end-stage liver disease.
- Patients weighing less than 13 kg represent a high-risk cohort in pediatric liver transplantation.
- Factors influencing survival include recipient age, weight, disease, vascular issues, and nutritional status.
Purpose of the Study:
- To assess the impact of low-weight pediatric patients (<13 kg) on the outcomes of a liver transplant program.
- To analyze the specific challenges and results associated with transplanting small children.
Main Methods:
- Retrospective review of 76 liver transplants in 59 pediatric patients from January 1986 to January 1992.
- Analysis of a subgroup of 14 patients weighing less than 13 kg.
- Comparison of rejection rates, graft survival, and patient survival between the low-weight group and other patients.
Main Results:
- The low-weight group (mean 11 kg, mean age 12 months) had a 64% patient survival rate at 4 years.
- Rejection incidence (52%) was not significantly different from the overall patient group (61%).
- Graft survival at 4 years was 47%, with complications including hepatic artery thrombosis and primary nonfunction.
Conclusions:
- Small infants (<13 kg) constitute a high-risk group in pediatric liver transplantation.
- Despite challenges, outcomes for this group can be evaluated within the context of overall program success.
- Further strategies may be needed to improve outcomes for very young and low-weight recipients.
Abstract:
Pediatric liver transplantation is an effective treatment for end-stage liver disease with 1- and 5-year survivals approaching 90% and 70%, respectively. Survival is influenced by the recipient's age, weight, primary disease, vascular malformations, and nutritional status. Younger patients weighing less than 13 kg are considered to be a high-risk group. The aim of this article is to evaluate the impact of this group of patients on the overall results of our pediatric liver transplant program. From January 1986 through January 1992 we performed 76 liver transplants in 59 pediatric patients. Sixteen received a second graft and a third was required in one. Fourteen patients weighed less than 13 kg (mean, 11 kg; range, 6 to 13 kg). Their mean age was 12 months, with a range of 8 to 36 months. Indications for transplantation were: biliary atresia (9), Byler's disease (1), tyrosinemia (3), and alpha 1-antitrypsin deficiency (1). The incidence of rejection in this group (52%) was not significantly different from that in other patients (61%). Ten episodes of acute rejection required only steroids: in one monoclonal antibodies were added. Five patients had a new graft implanted, four for hepatic artery thrombosis and one for primary liver nonfunction. Nine patients are alive (64%) with the follow-up time ranging from 2 to 56 months (mean, 31). Five patients died of multiorgan failure (3), portal vein thrombosis (1), and primary liver nonfunction (1). Four-year graft and patient survival rates were 47% and 64%, respectively. Small babies are a high-risk group in a pediatric liver transplant program.(ABSTRACT TRUNCATED AT 250 WORDS)