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Infant pediatric liver transplantation results equal those for older pediatric patients
W J Van der Werf1, A M D'Alessandro, S J Knechtle
1Department of Surgery, University of Wisconsin School of Medicine, Madison 53792-7375, USA.
Insights
Pediatric orthotopic liver transplantation (OLT) is safe and effective across all age groups, including infants. Age should not be a barrier to OLT, as survival rates are comparable regardless of the patient's age at transplant.
Area of Science:
- Pediatric Surgery
- Hepatology
- Transplantation Medicine
Background:
- Orthotopic liver transplantation (OLT) is a critical treatment for end-stage liver disease in children.
- Evaluating the impact of patient age on OLT outcomes is essential for optimizing treatment strategies.
Purpose of the Study:
- To retrospectively analyze the outcomes of pediatric orthotopic liver transplantation (OLT) across different age groups.
- To compare the efficacy and safety of OLT in infants and children of varying ages.
Main Methods:
- A retrospective analysis of 127 OLTs performed on 99 pediatric patients between July 1984 and July 1995.
- Patients were categorized into four age groups: 0-6 months, 6-12 months, 1-2 years, and 2-18 years.
- Comparison of preoperative factors, intraoperative techniques, complications, and survival rates among the age groups.
Main Results:
- Biliary atresia was the most common indication for OLT across all age groups.
- While younger infants (0-6 months) had longer ICU stays, overall hospital stay and complication rates (hepatic artery thrombosis, biliary complications, retransplantation) were not significantly different between groups.
- Survival rates for patients and primary liver allografts were comparable across all four age groups, with no statistically significant differences observed.
Conclusions:
- Pediatric orthotopic liver transplantation (OLT) is an effective procedure for infants of all ages.
- Age should not be a limiting factor, and OLT should not be delayed based on a patient's age.
Methods:
From July 1984 to July 1995, 99 pediatric patients underwent 127 orthotopic liver transplants (OLT) at the University of Wisconsin Children's Hospital. The patients were divided into four groups according to age at time of transplant: group I, 0 to 6 months (n = 20); group II, 6 to 12 months (n = 18); group III, 1 to 2 years (n = 10); and group IV, 2 to 18 years (n = 51). A retrospective analysis was performed to compare these four groups with regard to preoperative indications and demographics, intraoperative technique, complications, and survival. All patients were followed up for 2 to 13 years.
Results:
Biliary atresia was the most common indication for OLT in all four groups. The average waiting period varied from 19+/-18 days for group I to 44+/-64 days for group IV. Reduced-size liver transplant (I, 41%; II, 52%; III, 28%; IV, 21%), split-liver transplant (I, 0%; II, 7.4%; III, 17%; IV, 2.9%), or whole-liver transplant techniques were used. Although postoperative Intensive Care Unit stay was longer for the 0- to 6-month-old patients (I, 20+/-64; II, 7.6+/-9; III, 13+/-17; IV, 6.8+/-14 days), the total hospital stay (I, 43+/-63; II, 33+/-34; III, 32+/-20; IV, 29+/-31 days) was similar for all patients. The incidence of hepatic artery thrombosis (I, 19%; II, 19%; III, 27%; IV, 16%), biliary tract complications (I, 4.8%; II, 15%; III, 20%; IV, 14%), and retransplantation (I, 9.5%; II, 41%; III, 33%; IV, 14%) were not significantly different between the four groups. Portal vein thrombosis (I, 9.5%; II, 11%; III, 6.6; IV, 0%) and primary nonfunction (I, 9.5%; II, 7.4%; III, 0%; IV, 3.1%) occurred more frequently in the 0- to 6-month and 6- to 12-month groups, however, the 1-, 5-, and 10-year survival rate for patients (I, 85%, 79%, 79%; II, 89%, 74%, 74%; III, 80%, 80%, 80%; IV, 84%, 75%, 75%, respectively) and primary liver allografts (I, 69%, 69%, 69%; II, 72%, 72%, 63%; III, 70%, 70%, 70%; IV, 71%, 57%, 57%, respectively) were not significantly different (P = .98 and P = .83).
Conclusion:
These results demonstrate that OLT can be effectively performed on infants of all ages and that OLT should not be delayed because of age.