Hepatic transplantation in children under 3 months of age: A single centre's experience (original) (raw)

Liver Transplantation in Infants Younger than 1 Year of Age

Annals of Surgery, 1996

The authors report on experience with liver transplantation for infants younger than 1 year of age. Summary Background Data Over the last 15 years, orthotopic liver transplant has become the only lifesaving procedure available for infants with end-stage liver disease. Many transplant centers initially required infants to reach a specific weight or age to minimize morbidity and mortality. Size-appropriate infant donors also were uncommon. As a result, many children, in the first few years of life, died of their disease. The availability of reduced-size cadaveric and living-related liver transplants has offered the ability to transplant the young infant with liver failure. Methods The authors instituted a program to aggressively transplant infants with liver failure in the first year of life using both cadaveric and living-related liver donors. Results Between June 1991 and January 1995, 13 infants were transplanted for rapidly progressive liver failure. Infant age ranged from 4 to 11 months (mean, 7.5 months). The cause of liver failure included biliary atresia (1 1), a1-antitrypsin deficiency (1), and liver failure secondary to echovirus 7 (1). The United Network for Organ Sharing status at the time of transplant ranged from status 4, intensive care unit bound (4 patients); status 3, hospitalized (4 patients); or status 2, failing at home (5 patients). Six patients (46%) received cadaveric whole organ (2) or segmental transplants (4). Seven patients (54%) received left lateral segment living-related transplants from parental donors. After operation, patients received cyclosporine or FK506-based immunosuppression. Three patients (23%) required four retransplants (two cadaveric for primary nonfunction; one living-related for graft thrombosis in the face of fungal infection and bile leak). Postoperative complications included primary nonfunction (15%), rejection (85%), graft vascular thrombosis (15%, two of three revascularized successfully), bacterial and fungal infections (77%), and viral infections (46%). Epstein-Barr virus-associated lymphoproliferative developed in two patients (15%). Intestinal perforation requiring reoperation developed in two patients (15%). Bile leaks requiring reoperation or transhepatic stinting or both developed in three patients (23%). Two patients died in the perioperative period (< 1 month) from a combination of primary nonfunction or graft thrombosis and sepsis. Overall survival was 85%, ranging from 11.0 months to 4.5 years. Conclusions Orthotopic liver transplantation in infants younger than 1 year of age poses significant challenges from technical and infectious complications. Despite these barriers, overall patient survival is comparable to that of older children and adults.

Paediatric liver transplantation: the surgical view

Postgraduate Medical Journal, 2004

Liver transplantation is the accepted treatment for a wide variety of liver diseases in children. Over the past 10 years a number of innovative surgical techniques have been developed to overcome the shortage of size matched donors particularly in children less than 5 years of age. Graft and patient survival at one year after liver transplantation has continued to improve, and is now over 85% and higher for good risk cases. Complications are relatively common, but provided graft function is satisfactory, long term survival for these children is to be expected. The need for retransplantation has fallen significantly. Causes of early mortality include graft dysfunction and sepsis. Late mortality is due to sepsis, posttransplant lymphoproliferative disease, and noncompliance. Long term survival with good graft function and excellent quality of life is possible for the majority of children undergoing liver transplantation.

Pediatric Liver Transplantation: The University of Padua Experience

Transplantation Proceedings, 2007

Objective. The objective of this study was to analyze experience on pediatric liver transplantation (LT) between June 1993 and September 2006, including split liver transplantation (SLT), living donor liver transplantation (LDLT), and auxiliary partial orthotopic liver transplantation (APOLT). Furthermore, hepatocyte transplantation (HT) had a role in one patient with metabolic disease. Methods. From November 1990 to September 2006, 657 LTs were performed including 63 pediatric LTs (9.6%) in 57 patients (32 boys and 25 girls). Six were retransplantations (9.5%). Thirty-two patients (57%) were younger than 5 years. The types of graft included the following: 26 whole organs (41%), 32 in situ split organs (51%), 4 reduced-size organs (6%), and 1 graft from a living donor (2%). Two patients received an APOLT, 4 patients received a combined kidney-liver transplantation (CKLT), and 1 patient received HT. Of the 63 pediatric LTs, 16 were behaved to be highly urgent (25%). Results. Overall 1-, 3-, 5-, and 10-year patient survival rates were 82%, 82%, 78%, and 78%, respectively. Overall 1-, 3-, 5-, and 10-year graft survival rates were 76%, 76%, 72%, and 72%, respectively. In patients younger than 1 year, the 5-year survival rate was 100%. Perioperative mortality was 8.8%. Vascular complications occurred in 4 patients (6.3%). Six children required retransplantation due to primary nonfunction (PNF) in 4 cases (7%) and vascular thrombosis in 2 cases (3.5%). Conclusions. Cholestatic liver disease and age younger than 1 year were the best prognostic factors for excellent survival.

Pediatric Liver Transplantation: A Surgical Perspective and New Concepts

Current Transplantation Reports, 2014

The first successful liver transplantation was carried out in 1967, and the recipient was a pediatric patient. Since then, many challenges have been overcome and, nowadays, 1-year patient survival after liver transplantation is about 90 % in pediatric patient populations. Standardization of surgical technique, development of better immunosuppressive medications, improved understanding of caring for patients with end-stage liver disease, and improvements in anesthesia and intensive care have had a tremendous impact on graft and patient survival. Despite all improvements, challenging issues in pediatric liver transplantation remain. In this article, we address some of these problems. and living donor liver transplantation (LDLT); improvement of intensive care treatment; development of new immunosuppressive medications; improved understanding of the balance between immunosuppression and opportunistic infection; and the adoption of a multidisciplinary team approach to patient care, which includes collaboration between transplant surgery, pediatric hepatology, pediatric intensive care, nephrology, pulmonary, cardiology, infectious disease, psychiatry, social work, pharmacy, and nutrition.

Lessons from the first 100 liver transplantations in children at Bicêtre Hospital

Journal of Pediatric Surgery, 1994

0 The authors report their experience with 100 liver transplantations at BicOtre Hospital. From 1988 to 1991, 85 children received a total of 100 liver grafts (mean age, 44.4 months; two thirds were under 3 years of age). Fifty-four percent of the grafts were reduced-size. Cyclosporine, steroids, and azathioprine were used for immunosuppression. The actuarial survival rate at 4 years is 88%. Retransplantation was performed in 14 children (18%). Forty-four patients (49%) had another operation. Biliary complications (17%). hepatic artery thrombosis (HAT) (14%), and hemoperitoneum (14%) were the most frequent surgical complications. Retransplantation was avoided in 50% of the patients who underwent urgent artery revision for thrombotic complications. It appeared that ABO-incompatible were better tolerated in children without ABO alloantibodies at the time of transplantation. The survival rates of ABO-identical, -compatible, and -incompatible liver grafts did not differ (61%. 50%, and 57% respectively). The results suggest that an agressive policy of reintervention, including retransplantation, is necessary to achieve a satisfactory survival rate and quality of life. Children lacking ABO alloantibodies at the time of transplantation might tolerate ABO-incompatible liver grafts better.

Liver transplantation in small babies

Journal of Pediatric Surgery, 1993

is an effective treatment for end-stage liver disease with 'I-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 1886 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 (4, and al-antitripsin 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 (11, 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. There is a higher incidence of vascular complications but both rejection and survival rates are not significantly different from those in older recipients.

Liver transplantation in infants

Journal of Pediatric Surgery, 1999

In view of the earlier reports that children below 1 year of age constitute a high-risk group for liver transplantation, the authors reviewed their experience in performing orthotopic livertransplantation in this age group. Methods:The records of 9 children aged less than 1 year who underwent 6 living-related liver transplants and 3 reducedsize liver transplants between December 1993 and June 1997 were reviewed.

Pediatric liver transplantation: Review of literature 2003-2005

Pediatric Transplantation, 2006

Abstract: Over the years, significant developments have been made in the field of pediatric liver transplantation. Better patient and graft survival, new immunosuppressive agents and strategies and the availability of long-term outcomes have resulted in a wealth of literature. Between January 2003 and August 2005, more than 1200 articles related to pediatric liver transplantation have been published in various journals. We have attempted to summarize the clinical studies of direct relevance in this field. This review of 25 articles is by no means exhaustive and is meant as a guide for quick reference and further reading.