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Successful liver transplantation in babies under 1 year
Insights
Liver transplantation in infants under one year old shows an 88% survival rate, significantly improving growth and quality of life. This highlights the benefits of early intervention for critically ill babies needing liver transplants.
Area of Science:
- Pediatric surgery
- Hepatology
- Transplant medicine
Background:
- Infants under one year often present with severe decompensated liver disease and malnutrition.
- Liver transplantation is a critical intervention for this demographic.
Purpose of the Study:
- To evaluate the outcomes of liver transplantation in infants less than one year old.
- To assess survival, complications, and developmental status post-transplant.
Main Methods:
- Prospective evaluation of 25 infants undergoing liver transplantation between 1989 and 1992.
- Assessment of clinical, nutritional, and developmental status before and one year after transplantation.
Main Results:
- An overall actuarial survival rate of 88% was achieved.
- Significant improvements in growth (p < 0.001) and psychosocial development were observed at 12 months.
- Common complications included sepsis, biliary obstruction, and rejection; 18% of infants required a second transplant.
Conclusions:
- Liver transplantation offers improved survival and quality of life for critically ill infants.
- Advances in surgical techniques (reduction hepatectomy) and medical expertise contribute to better outcomes.
- Early referral for liver transplantation is crucial, even for critically ill infants.
Objective:
To review the outcome of liver transplantation in babies aged less than 1 year.
Design:
Prospective evaluation of survival, clinical complications, and nutritional and developmental status before and one year after liver transplantation.
Setting:
The Children's Hospital and Queen Elizabeth Hospital, Birmingham.
Subjects:
All 25 babies who received liver transplantation from January 1989 to December 1992 were included. Median age was 9 months and median weight was 7.0 kg. Seven babies were assessed but were not given transplants because they died while on the waiting list (two) or had severe extrahepatic disease (five).
Results:
24 babies had severe decompensated liver disease and 20 were severely malnourished despite nutritional support. Six babies received a whole liver graft and 19 received a reduction hepatectomy. Postoperative complications included primary nonfunction of the transplanted liver (one baby), hepatic artery thrombosis (two), biliary obstruction (seven), acute and chronic rejection (six), and sepsis (18). Three babies required a second transplant; all survived. Three babies, two of whom presented with fulminant hepatic failure, died. The overall actuarial survival rate (4 months to 4 years) is 88%. Review at 12 months showed a dramatic improvement in growth (p < 0.001) and normal psychosocial development with good quality of life.
Conclusion:
The improvement in survival rates and quality of life in this group of very sick babies is related not only to the development of reduction hepatectomy but also to advances in medical and nursing expertise. Early referral for liver transplantation is justified even if babies are critically ill.