Sa1696 Outcomes of Liver Transplantation in Children Younger Than One Year of Age (original) (raw)

Introduction: Orthotopic liver transplantation (OLT) is a life-saving procedure for children with end-stage liver disease. Advances in surgical techniques have made OLT in children younger than one year of age increasingly feasible. Previous studies have suggested that infants may experience high operative complications, difficult post-operative courses, and poor graft and patient survival. Many transplant centers have required infants to reach a specific weight or age prior to OLT to minimize morbidity and mortality. As a result, many children have died or experienced significant decompensation while awaiting the required weight or age, thereby making them worse candidates for the procedure. Aim: To review our single center experience with OLT in children younger than one year of age at the time of transplantation. Methods: We retrospectively reviewed the charts of patients 365 days of age and younger that underwent OLT at Morgan Stanley Children's Hospital of New-York Presbyterian from 1998 to 2014. We specifically reviewed data related to intraoperative course, length of hospitalization, duration of stay in intensive care unit (ICU), duration of mechanical ventilation, post-transplant complications within 90 days and 90-day and 1year patient and graft survival. Results: Data for 65 of 116 eligible patients were included in this interim analysis (median age:240 days, range:21-365 days; median weight:5.9 kg, range:2.0-8.5 kg). The most common indications for OLT were biliary atresia (n= 51, 78.5%) and cryptogenic cirrhosis (n=5, 7.7%). Forty-three patients (66.2%) received deceased donor grafts, of which 55.8% were whole organs. Mean duration of transplant surgery was 7.2 hours. Intra-operatively, 53 patients (89.8%) required blood transfusions (mean:72 mL/kg), 32 patients (55.2%) required fresh frozen plasma (mean:48 mL/kg) and 6 patients (11.8%) required platelet transfusions (mean:13 mL/kg). Median post-transplant hospitalization was 17 days, ICU stay was 8 days, and mechanical ventilation duration was 2 days. Posttransplant complications included bile leak (26.2%), acute rejection (18.5%), hepatic artery thrombosis (13.8%), portal vein thrombosis (13.8%), wound dehiscence (13.8%), abdominal compartment syndrome (9.2%), and bleeding (9.2%). The reoperation rate was 49.2%. Four patients required re-transplantation, 2 of whom died. Patient survival was 93.8% at both 90 days and 1 year. Graft survival was 90.8% at 90 days and 89.2% at 1 year. Conclusion: Infants can have excellent outcomes after OLT with acceptable operative complications and high survival rates in a center of excellence. The use of partial or whole grafts can yield patient and graft survivals approaching that of children greater than 1 year of age. OLT should not be delayed in infants merely because of low weight or young age, reducing pretransplant morbidity and mortality.