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Boillot O, Guillaud O, Wischlen E, Ruiz M, Boucaud C, Rohmer B, Lachaux A, Rivet C, Laverdure N, Dumortier J. Determinants of early surgical complications after pediatric liver transplantation: A single center/single surgeon experience over 20 years. Clin Res Hepatol Gastroenterol 2023; 47:102222. [PMID: 37783384 DOI: 10.1016/j.clinre.2023.102222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND The risk of early surgical complications of liver transplantation (LT) is higher in children when compared with adults. The aims of the present retrospective study from a single center cohort/single surgeon were to identify the predictive factors for surgical complications after pediatric LT. METHODS All children receiving a first LT from October 1990 to October 2010 in our center were included. RESULTS Included 151 children (boys 55.0%), with a mean age of 4.8 ± 4.8 years, and a mean weight of 17.9 ± 14.4 kg. Thirty-seven patients were transplanted within the first year, and 59 patients had a body weight below 10 kg. The main initial liver disease was biliary atresia (49.0%). Living donor LT was performed in 39 cases (25.8%), cadaveric whole liver LT in 50 cases (33.1%), and cadaveric partial liver LT in 62 cases (41.1%). Early surgical complications included reoperation (37.8%), vascular complications (8.6%), i.e. arterial (3.3%) or portal thrombosis/stenosis (7.3%) within the first month, and biliary complications in the first 90 days occurred in 22.5% of the cases. The main indications for surgical revision were abdominal bleeding, treatment of a biliary complication, and bowel perforation. Multivariate analysis disclosed that only graft type (split and moreover from a living donor) was significantly and independently associated with the occurrence of biliary complication, and that indication for LT, period, graft type, and operative time were significantly and independently associated with the necessity of surgical revision. CONCLUSION Our results emphasize that surgical complications are frequent and strongly depend on patient/graft characteristics.
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Affiliation(s)
- Olivier Boillot
- Department of Digestive Diseases, Edouard Herriot Hospital, Hospices Civils de Lyon, France; University Claude Bernard Lyon 1, France
| | - Olivier Guillaud
- Department of Digestive Diseases, Edouard Herriot Hospital, Hospices Civils de Lyon, France; Ramsay Générale de Santé, Clinique de la Sauvegarde, France
| | - Emma Wischlen
- Department of Pediatric Hepatogastroenterology and Nutrition, Centre National de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, France
| | - Mathias Ruiz
- Department of Pediatric Hepatogastroenterology and Nutrition, Centre National de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, France
| | - Catherine Boucaud
- Department of Anesthesiology, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, Lyon, France
| | - Barbara Rohmer
- Department of Pediatric Hepatogastroenterology and Nutrition, Centre National de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, France
| | - Alain Lachaux
- University Claude Bernard Lyon 1, France; Department of Pediatric Hepatogastroenterology and Nutrition, Centre National de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, France
| | - Christine Rivet
- Department of Pediatric Hepatogastroenterology and Nutrition, Centre National de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, France
| | - Noémie Laverdure
- Department of Pediatric Hepatogastroenterology and Nutrition, Centre National de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, France
| | - Jérôme Dumortier
- Department of Digestive Diseases, Edouard Herriot Hospital, Hospices Civils de Lyon, France; University Claude Bernard Lyon 1, France.
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Hartleif S, Hodson J, Lloyd C, Cousin VL, Czubkowski P, D'Antiga L, Debray D, Demetris A, Di Giorgio A, Evans HM, Fischler B, Gonzales E, Gouw ASH, Hübscher SG, Jacquemin E, Lacaille F, Malenicka S, McLin VA, Markiewicz-Kijewska M, Mazariegos GV, Rajanayagam JK, Scheenstra R, Singer S, Smets F, Sokal E, Squires JE, Sturm E, Verkade H, Kelly DA. Long-term Outcome of Asymptomatic Patients With Graft Fibrosis in Protocol Biopsies After Pediatric Liver Transplantation. Transplantation 2023; 107:2394-2405. [PMID: 37143195 DOI: 10.1097/tp.0000000000004603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND The histological prevalence of allograft fibrosis in asymptomatic children after liver transplantation (LT) is well documented. However, long-term graft and patient survival remain unclear. This retrospective multicenter study aims to determine the prevalence of allograft fibrosis and analyze the long-term outcome for patients transplanted in childhood. METHODS We reviewed clinical data of children who had undergone 10-y protocol liver biopsies. We excluded patients with autoimmune hepatitis, primary sclerosing cholangitis, hepatitis B or C, and retransplantation. In total, 494 patients transplanted in childhood across 12 international transplant centers were included. We evaluated the development of fibrosis by comparing the results with biopsies obtained 5 and 15 y post-LT. Histological findings were correlated with graft and patient survival up to 20 y post-LT. RESULTS In the 10-y biopsies, periportal or pericentral fibrosis was observed in 253 patients (51%), 87 (18%) had bridging fibrosis, 30 (6%) had cirrhosis, and 124 (25%) had no fibrosis. The prevalence and stage of graft fibrosis significantly progressed from 5 to 10 y. At 10 y, the severity of fibrosis correlated significantly with inflammation. Patients with graft cirrhosis in the 10-y biopsy were more likely to die or require retransplantation subsequently ( P = 0.027). CONCLUSIONS At 10 y post-LT, most patients transplanted in childhood developed fibrosis, based on the protocol liver biopsies. Although mild-to-moderate graft fibrosis did not largely affect patient or graft survival up to 20 y post-LT, this progressive fibrosis finding has substantial implications for developing cirrhosis and portal hypertension in adult care.
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Affiliation(s)
- Steffen Hartleif
- Pediatric Gastroenterology and Hepatology, University Hospital Tübingen, Tübingen, Germany
| | - James Hodson
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Translational Medicine, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Carla Lloyd
- Liver Unit, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
| | - Vladimir L Cousin
- Swiss Pediatric Liver Centre, Division of Pediatric Specialties, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals Geneva and University of Geneva, Geneva, Switzerland
| | - Piotr Czubkowski
- Department of Liver Disorders and Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Lorenzo D'Antiga
- Pediatric Hepatology, Gastroenterology and Transplantation, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Dominique Debray
- Pediatric Liver Unit, National Reference Centre for Rare Pediatric Liver Diseases (Biliary Atresia and Genetic Cholestasis), FILFOIE, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Anthony Demetris
- Division of Liver and Transplantation Pathology, Department of Pathology, University of Pittsburgh, Pittsburgh, PA
| | - Angelo Di Giorgio
- Pediatric Hepatology, Gastroenterology and Transplantation, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Helen M Evans
- Department of Pediatric Gastroenterology, Starship Child Health, University of Auckland, Auckland, New Zealand
| | - Björn Fischler
- Pediatric Digestive Diseases, Astrid Lindgren Children's Hospital, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Emmanuel Gonzales
- Hépatologie et Transplantation Hépatique Pédiatriques, Centre de référence de l'atrésie des voies biliaires et des cholestases génétiques, FSMR FILFOIE, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Kremlin-Bicêtre, France
| | - Annette S H Gouw
- Department of Pathology and Medical Biology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Stefan G Hübscher
- Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Emmanuel Jacquemin
- Hépatologie et Transplantation Hépatique Pédiatriques, Centre de référence de l'atrésie des voies biliaires et des cholestases génétiques, FSMR FILFOIE, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Kremlin-Bicêtre, France
| | - Florence Lacaille
- Pediatric Liver Unit, National Reference Centre for Rare Pediatric Liver Diseases (Biliary Atresia and Genetic Cholestasis), FILFOIE, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Silvia Malenicka
- Pediatric Digestive Diseases, Astrid Lindgren Children's Hospital, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Valerie A McLin
- Swiss Pediatric Liver Centre, Division of Pediatric Specialties, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals Geneva and University of Geneva, Geneva, Switzerland
| | | | - George V Mazariegos
- Department of Surgery, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Jeremy K Rajanayagam
- Paediatric Gastroenterology, Hepatology and Nutrition, The Royal Children's Hospital, Melbourne, Australia
| | - René Scheenstra
- Pediatric Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan Singer
- Institute of Pathology, University Hospital Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies," University of Tübingen, Tübingen, Germany
| | - Françoise Smets
- UClouvain, Clinical and Experimental Research Institute and Cliniques Universitaires Saint Luc, Service de Gastroentérologie Hépatologie Pédiatrique, Brussels, Belgium
| | - Etienne Sokal
- UClouvain, Clinical and Experimental Research Institute and Cliniques Universitaires Saint Luc, Service de Gastroentérologie Hépatologie Pédiatrique, Brussels, Belgium
| | - James E Squires
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Ekkehard Sturm
- Pediatric Gastroenterology and Hepatology, University Hospital Tübingen, Tübingen, Germany
| | - Henkjan Verkade
- Pediatric Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Deirdre A Kelly
- Liver Unit, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
- University of Birmingham, Birmingham, United Kingdom
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Lund LK, Grabhorn EF, Rüther D, Buchholz A, Lang M, Herden U, Fischer L, Sterneck M. Long-term Outcome of Pediatric Liver Transplant Recipients Who Have Reached Adulthood: A Single-center Experience. Transplantation 2023; 107:1756-1763. [PMID: 36814096 DOI: 10.1097/tp.0000000000004556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND As long-term survival of pediatric liver transplant recipients increases, the assessment of physical, psychological, and social well-being becomes more important. METHODS In this retrospective analysis, 120 young adult patients (age ≥18 y) who underwent liver transplantation in childhood were studied. Patients with ideal outcome were defined as patients with perfect graft function, with no complications from the immunosuppressive medication, no late retransplantation, and no steroid treatment. Also, the patients' drug adherence and their psychosocial situation were assessed. RESULTS After a median follow-up of 19 y, only 16.7% of the patients (mean age: 26.5 y) were considered patients with ideal outcome. The main reasons precluding ideal outcome were chronic kidney disease (38.3%), elevated liver enzymes (33.3%), and arterial hypertension (31.7%). Ideal outcome decreased over time from 54% to 42%, 26%, and 8% at 10-, 15-, 20-, and 25-y follow-up, respectively. Reduced drug adherence was noted in 24.8% of patients and associated with a significantly higher prevalence of donor-specific antibodies class II ( P = 0.015), elevated transaminases ( P = 0.010), and chronic rejection ( P < 0.001). Also, 15% of patients had a psychiatric disease, mainly depression. CONCLUSIONS The morbidity of young adults who underwent liver transplantation as children was high and increased over time. The majority developed complications from immunosuppression or chronic graft dysfunction. More than 1 in 7 patients had a psychiatric disease and 1 in 4 was not perfectly drug adherent. Therefore, immunosuppressive treatment and psychological care should be optimized for these particularly vulnerable patients.
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Affiliation(s)
- Louisa Katharina Lund
- Department of Medicine, University Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Enke Freya Grabhorn
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Darius Rüther
- Department of Medicine, University Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angela Buchholz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Melanie Lang
- Department of Medicine, University Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Herden
- Department of Visceral Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Fischer
- Department of Visceral Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martina Sterneck
- Department of Medicine, University Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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4
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Polat KY, Yazar Ş, Aslan S, Kargı A, Selimoğlu A, Gürbulak B, Astarcıoğlu İ. Comparing the Outcomes of Pediatric Liver Transplantation. Transplant Proc 2023:S0041-1345(23)00319-6. [PMID: 37302864 DOI: 10.1016/j.transproceed.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 05/12/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Liver transplantation is a life-saving treatment for end-stage pediatric liver failure. We aimed to present the results of pediatric liver transplants performed in our center in the last 11 years (between 2012 and March 2022) in association with prognostic factors affecting survival. METHODS Demographic characteristics, etiologic reasons, previous operations (Kasai procedure), morbidity, mortality, survival, and bilio-vascular complication rates were determined, and outcomes were evaluated. In the postoperative period, the duration of mechanical ventilation and intensive care unit stay and surgical and other complications were evaluated. Graft and patient survival rates were determined, and univariate and multivariate factors affecting these rates were evaluated. RESULTS In the last 10 years, 229 pediatric liver transplantaion (Pe-LT)/1513 adult liver taransplantation (Ad-LT) (21.35%) were performed in our center. This ratio (Pe-LT/Ad-LT ratio) is 1741/15,886 (10.95%) for our country. A total of 229 liver transplants were performed in 214 pediatric patients. Retransplantation was performed in 15 patients (6.55%). Cadaveric liver transplantation was performed in 9 patients. Graft survival rates were 87%, 83%, 78%, 78%, 78%, and 78% at <30 days, 30 to 90 days, 91 to 364 days, 1 to 3 years, and >3 years, respectively. Patient survival rates for <30 days, 30 to 90 days, 91 to 364 days, 1 to 3 years, and >3 years were 91.5%, 85.7%, 82%, 81.5%, and 81.5%, respectively. Our 5-year survival rates in metabolic diseases and the acute fulminant failure group are 93.8% and 100%, respectively. CONCLUSIONS The fact that the 1- and 5-year survival rates are the same shows that when patients overcome biliary vascular and infectious problems, their survival is prolonged.
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Affiliation(s)
- Kamil Yalçın Polat
- Organ Transplantation Center, Bahçelievler Memorial Hospital, Istanbul, Turkey
| | - Şerafettin Yazar
- Organ Transplantation Center, Bahçelievler Memorial Hospital, Istanbul, Turkey
| | - Serdar Aslan
- Organ Transplantation Center, Bahçelievler Memorial Hospital, Istanbul, Turkey
| | - Ahmet Kargı
- Organ Transplantation Center, Bahçelievler Memorial Hospital, Istanbul, Turkey
| | - Ayşe Selimoğlu
- Department of Pediatric Gastroenterology, Bahçelievler Memorial Hospital, Istanbul, Turkey
| | - Bünyamin Gürbulak
- Organ Transplantation Center, Bahçelievler Memorial Hospital, Istanbul, Turkey.
| | - İbrahim Astarcıoğlu
- Organ Transplantation Center, Bahçelievler Memorial Hospital, Istanbul, Turkey
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5
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Avanaz A, Ünal DS, Kisaoglu A, Yilmaz VT, Moharer PS, Demiryilmaz I, Aydinli B. The Factors Affecting Mortality After Pediatric Liver Transplantation and Long-Term Survival Outcomes: A Single Center Experience. Transplant Proc 2023:S0041-1345(23)00165-3. [PMID: 37105828 DOI: 10.1016/j.transproceed.2023.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/05/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Liver transplantation (LT) is a treatment modality in the pediatric population for several diseases like biliary atresia, metabolic liver disease, hepatoblastoma, and so on. According to the Organ Procurement and Transplantation Network, 5-year survival was reported as 85.4% to 93.5% by age after pediatric liver transplantation (PLT). This study aimed to evaluate our single-center experience of PLT by analyzing long-term results, comparing the outcomes with the literature, and identifying predictors of patient survival. METHODS The data of 40 patients who underwent LT at <18 years of age between June 2015 and June 2021 were studied retrospectively. Recipient characteristics such as age, sex, etiology of liver disease follow-up time, postoperative vascular and biliary complications, and donor characteristics were evaluated. RESULTS There were 20 (50%) girls and 20 (50%) boys, and the median age was 42 (IQR = 9-117) months. The most common indications of LT were biliary disorders (45%). A whole liver graft was used in 7 (17%), a right lobe graft in 9 (23%), a left lobe graft in 4 (10%), and a left lateral lobe graft in 20 (50%) of the recipients. The 1-, 3-, 5-, and 7-year survival rates were 85%, 82.1%, 82.1%, and 82.1%, respectively. The multivariate survival analysis revealed that the pediatric end-stage liver disease score, hepatic artery thrombosis, and portal vein thrombosis are associated with overall mortality. CONCLUSION In conclusion, our long-term survival is similar to the literature, with satisfactory results. However, reducing the vascular complication rates can provide superior results on PLT.
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Affiliation(s)
- Ali Avanaz
- Department of General Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Demet Sarıdemir Ünal
- Department of General Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey.
| | - Abdullah Kisaoglu
- Department of General Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Vural Taner Yilmaz
- Department of Internal Medicine, Division of Nephrology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | | | - Ismail Demiryilmaz
- Department of General Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Bulent Aydinli
- Department of General Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
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6
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Polat KY, Yazar Ş, Kargi A, Aslan S, Demirdağ H, Gürbulak B, Astarcioğlu İ. Comparing the Outcomes of Deceased-Donor and Living-Donor Liver Re-Transplantation In Adult Patients. Transplant Proc 2023:S0041-1345(23)00169-0. [PMID: 37085384 DOI: 10.1016/j.transproceed.2023.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/05/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Patients with liver graft failures have an extremely low chance of finding a cadaveric graft in countries with a scarcity of deceased donors. We compared the outcomes of liver re-transplantation with living-donor liver grafts (re-LDLT) and deceased-donor liver grafts (re-DDLT) in adult patients (>18 years). METHODS The medical records of 1513 (1417 [93.6%] LDLT and 96 [6.3%] DDLT) patients who underwent liver transplantation at Memorial Hospital between January 2011 and October 2022 were reviewed. Forty patients (24 adults and 16 pediatric) were re-transplanted (2.84%); 24 adult patients (2.72%: 25 re-LDLT, 1 patient with second re-LDLT) were divided into 2 groups: re-DDLT (n = 6) and re-LDLT (n = 18). The groups were compared in demographics, pre-, peri-, postoperative characteristics, and outcomes. RESULTS The overall survival rates were 91.7%, 79.2%, 75.0%, and 75% for <30 days, 31 to 90 days, 1, and 3 years, respectively. The LDLT group was significantly younger (P = .022), had smaller graft weight (P = .03), shorter mechanical ventilation (P = .036) but longer operation time (P = .019), and hospitalization period (P = .003). The groups were otherwise comparable. There was no statistically significant difference in survival rates between the groups (P = .058), although the re-LDLT group had an evidently higher survival rate (88.9% and 83.3 % vs 50.0%). CONCLUSION Re-LDLT has shown comparable outcomes to re-DDLT, if not better (even not far from significance P = .058). These results may encourage performing re-LDLTs in patients with indications for re-LT without worrying about low chances of survival, especially in countries with limited sources of deceased donors.
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Affiliation(s)
- Kamil Yalçin Polat
- Bahçelievler Memorial Hospital, Organ Transplantation Center, Istanbul, Turkey
| | - Şerafettin Yazar
- Bahçelievler Memorial Hospital, Organ Transplantation Center, Istanbul, Turkey
| | - Ahmet Kargi
- Bahçelievler Memorial Hospital, Organ Transplantation Center, Istanbul, Turkey
| | - Serdar Aslan
- Bahçelievler Memorial Hospital, Organ Transplantation Center, Istanbul, Turkey
| | - Hakan Demirdağ
- Bahçelievler Memorial Hospital, Department of Gastroenterology, Istanbul, Turkey
| | - Bünyamin Gürbulak
- Bahçelievler Memorial Hospital, Organ Transplantation Center, Istanbul, Turkey.
| | - İbrahim Astarcioğlu
- Bahçelievler Memorial Hospital, Organ Transplantation Center, Istanbul, Turkey
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7
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Alnagar AM, Hakeem AR, Daradka K, Kyrana E, Methga M, Palaniswamy K, Rajwal S, Mulla J, O'meara M, Upasani V, Vijayanand D, Prasad R, Attia MS. Long-term outcomes of pediatric liver transplantation in acute liver failure vs end-stage chronic liver disease: A retrospective observational study. World J Transplant 2023; 13:96-106. [PMID: 36968135 PMCID: PMC10037232 DOI: 10.5500/wjt.v13.i3.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/22/2022] [Accepted: 03/06/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Children with acute liver failure (ALF) who meet the criteria are eligible for super-urgent transplantation, whereas children with end-stage chronic liver disease (ESCLD) are usually transplanted electively. Pediatric liver transplantation (PLT) in ALF and ESCLD settings has been well described in the literature, but there are no studies comparing the outcomes in these two groups.
AIM To determine if there is a difference in post-operative complications and survival outcomes between ALF and ESCLD in PLT.
METHODS This was a retrospective observational study of all primary PLTs performed at a single center between 2000 and 2019. ALF and ESCLD groups were compared for pretransplant recipient, donor and operative parameters, and post-operative outcomes including graft and patient survival.
RESULTS Over a 20-year study period, 232 primary PLTs were performed at our center; 195 were transplanted for ESCLD and 37 were transplanted for ALF. The ALF recipients were significantly older (median 8 years vs 5.4 years; P = 0.031) and heavier (31 kg vs 21 kg; P = 0.011). Living donor grafts were used more in the ESCLD group (34 vs 0; P = 0.006). There was no difference between the two groups concerning vascular complications and rejection, but there were more bile leaks in the ESCLD group. Post-transplant patient survival was significantly higher in the ESCLD group: 1-, 5-, and 10-year survival rates were 97.9%, 93.9%, and 89.4%, respectively, compared to 78.3%, 78.3%, and 78.3% in the ALF group (P = 0.007). However, there was no difference in 1-, 5-, and 10-year graft survival between the ESCLD and ALF groups (90.7%, 82.9%, 77.3% vs 75.6%, 72.4%, and 66.9%; P = 0.119).
CONCLUSION Patient survival is inferior in ALF compared to ESCLD recipients; the main reason is death in the 1st year post-PLT in ALF group. Once the ALF children overcome the 1st year after transplant, their survival stabilizes, and they have good long-term outcomes.
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Affiliation(s)
- Amr M Alnagar
- Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria 21615, Egypt
- Liver and Transplant Surgery, The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds LS9 7TF, United Kingdom
| | - Abdul R Hakeem
- Liver and Transplant Surgery, The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds LS9 7TF, United Kingdom
| | - Khaled Daradka
- Liver and Transplant Surgery, The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds LS9 7TF, United Kingdom
| | - Eirini Kyrana
- Liver and Transplant Surgery, The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds LS9 7TF, United Kingdom
| | - Marumbo Methga
- Liver and Transplant Surgery, The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds LS9 7TF, United Kingdom
| | - Karthikeyan Palaniswamy
- Liver and Transplant Surgery, The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds LS9 7TF, United Kingdom
| | - Sanjay Rajwal
- Liver and Transplant Surgery, The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds LS9 7TF, United Kingdom
| | - Jamila Mulla
- Liver and Transplant Surgery, The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds LS9 7TF, United Kingdom
| | - Moira O'meara
- Liver and Transplant Surgery, The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds LS9 7TF, United Kingdom
| | - Vivek Upasani
- Liver and Transplant Surgery, The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds LS9 7TF, United Kingdom
| | - Dhakshinamoorthy Vijayanand
- Liver and Transplant Surgery, The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds LS9 7TF, United Kingdom
| | - Raj Prasad
- Liver and Transplant Surgery, The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds LS9 7TF, United Kingdom
| | - Magdy S Attia
- Liver and Transplant Surgery, The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds LS9 7TF, United Kingdom
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8
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Goetz M, Jurczyk M, Grothues D, Knoppke B, Junger H, Melter M, Schlitt HJ, Brunner SM, Brennfleck FW. Biological abdominal wall expansion in pediatric liver recipients after transplantation with large-for-size organs. Pediatr Transplant 2023; 27:e14405. [PMID: 36201376 DOI: 10.1111/petr.14405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/01/2022] [Accepted: 09/18/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND After pediatric split liver transplantation, intra-abdominal loss of domain due to large-for-size left lateral grafts is a frequent problem for fascial closure and potentially leads to reduced liver perfusion and abdominal compartment syndrome. Therefore, delayed fascial closure with the use of temporary silastic meshes and reoperation or alternative fascial bridging procedures are necessary. METHODS Between March 2019 and October 2021, biologic meshes were used for abdominal wall expansion in 6 cases of pediatric split liver transplantation. These cases were analyzed retrospectively. RESULTS One male and 5 female children with median age of 6 months (range: 0-57 months) and weight of 6 kg (range: 3.5-22 kg) received a large-for-size left lateral graft. Graft-to-recipient weight ratio (GRWR) was 4.8% (range: 1.5%-8.5%) in median. Biologic mesh implantation for abdominal wall expansion was done in median 7 days (range: 3-11 days) after transplantation when signs of abdominal compartment syndrome with portal vein thrombosis in 3 and of the liver artery in 1 case occurred. In 2 cases, bovine acellular collagen matrix and 4 cases ovine reinforced tissue matrix was used. Median follow-up was 12.5 months (range: 4-28 months) and showed good liver perfusion by sonography and normal corporal development without signs of ventral hernia. One patient died because of fulminant graft rejection and emergency re-transplantation 11 months after the initial transplantation. CONCLUSIONS Biologic meshes can be used as safe method for abdominal wall expansion to achieve fascial closure in large-for-size liver transplant recipients. Usage for primary fascial closure can be considered in selected patients.
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Affiliation(s)
- Markus Goetz
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Maria Jurczyk
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Dirk Grothues
- University Children's Hospital Regensburg (KUNO), University Medical Center Regensburg, Regensburg, Germany
| | - Birgit Knoppke
- University Children's Hospital Regensburg (KUNO), University Medical Center Regensburg, Regensburg, Germany
| | - Henrik Junger
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Michael Melter
- University Children's Hospital Regensburg (KUNO), University Medical Center Regensburg, Regensburg, Germany
| | - Hans J Schlitt
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Stefan M Brunner
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Frank W Brennfleck
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
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9
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Neto JS, Chapchap P, Feier FH, Pugliese R, Vincenzi R, Benavides MR, Roda K, Kondo M, Fonseca EA. The impact of low recipient weight [≤ 7kg] on long-term outcomes in 1078 pediatric living donor liver transplantations. J Pediatr Surg 2022; 57:955-961. [PMID: 35697543 DOI: 10.1016/j.jpedsurg.2022.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND infants who require liver transplantation represent a treatment challenge because chronic liver disease at this early age affects the child's growth and development during a critical phase. The aim is to compare demographics, operative data, and long-term outcomes according to recipient weight at the time of LDLT. METHODS This retrospective study included primary LDLT analyzed in 2 groups: BW ≤ 7 kg (n = 322) and BW > 7 kg (n = 756). A historical comparison between periods was also investigated. RESULTS BW ≤ 7 kg had significantly lower height/age and weight/age z-scores, with median PELD score of 19. Transfusion rates were higher in the BW ≤ 7 kg group (30.9 ml/kg versus 15.5 ml/kg, P < 0.001). Higher frequencies of PV complications were seen in the BW ≤ 7 kg cohort. HAT and retransplantation rates were similar. Those with BW ≤ 7 kg required longer ICU and hospital stays. Patient and graft survival were similar. Patient survival in BW≤ 7 kg was significantly better in the most recent period. CONCLUSION Malnutrition and advanced liver disease were more frequent in BW ≤ 7 kg. Despite increased rates of PVT and longer hospital stay, patient and graft long-term survival were similar between groups.
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Affiliation(s)
- João Seda Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil; Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil.
| | - Paulo Chapchap
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil
| | - Flavia H Feier
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Renata Pugliese
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil; Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil
| | - Rodrigo Vincenzi
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil; Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil
| | - Marcel R Benavides
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil; Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil
| | - Karina Roda
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil; Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil
| | - Mário Kondo
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil
| | - Eduardo A Fonseca
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro, 414, cj 65, Bela Vista, SP, Brazil; Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil; Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brazil
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10
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Squires JE, Bilhartz J, Soltys K, Hafberg E, Mazariegos GV, Gupta NA, Anand R, Anderson SG, Miloh T. Factors associated with improved patient and graft survival beyond 1 year in pediatric liver transplantation. Liver Transpl 2022; 28:1899-1910. [PMID: 35555876 DOI: 10.1002/lt.26502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 01/13/2023]
Abstract
With advances in surgical techniques, medical management, and more equitable allocation systems, children who receive a liver transplantation (LT) today can expect remarkable outcomes early after LT. However, beyond 1 year after transplant, attrition rates have not improved. We reviewed two separate eras (Era 1: January 1995-June 2004 vs. Era 2: July 2004-March 2018) of the Society of Pediatric Liver Transplantation registry to explore the evolution and associated factors contributing to late graft loss (LGL) and late mortality (LM). The fraction of long-term pediatric LT recipients surviving after 1 year with their first graft significantly improved (81.5% in Era 1 vs. 85.7% in Era 2; p < 0.0001). This improvement occurred despite significant changes in patient selection toward higher risk populations (p < 0.001) and without notable improvement in perioperative complications such as hepatic artery thrombosis (p = 0.24) and early posttransplant reoperation (p = 0.94) that have historically contributed to poor late-allograft outcomes. Improved outcomes were associated with changes in patient characteristics and perioperative practices, which subsequently impacted both early post-LT complications as well as other sequalae known to contribute to adverse events in long-term pediatric LT recipients. In conclusion, despite significant changes in patient selection toward higher risk populations, and without notable improvement in several perioperative complications known to contribute to poor late-allograft outcomes, significant improvements in LGL and a trend toward improvement in LM was seen in a more contemporary cohort of children receiving an LT.
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Affiliation(s)
- James E Squires
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jacob Bilhartz
- C. S. Mott Children's Hospital, University of Michigan Health, Ann Arbor, Michigan, USA
| | - Kyle Soltys
- Hillman Center for Pediatric Transplantation, Thomas E. Starzl Transplantation Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Einar Hafberg
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - George V Mazariegos
- Hillman Center for Pediatric Transplantation, Thomas E. Starzl Transplantation Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nitika A Gupta
- Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | - Tamir Miloh
- Department of Pediatrics, University of Miami, Miami, Florida, USA
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11
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Feng H, Xi ZF, Kasahara M, Xia Q. Pediatric liver transplantation: progress in optimizing long-term outcomes and directions for future research. Sci Bull (Beijing) 2022; 67:1929-1931. [PMID: 36546196 DOI: 10.1016/j.scib.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Hao Feng
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Engineering Research Centre of Transplantation and Immunology, Shanghai 200127, China; Shanghai Institute of Transplantation, Shanghai 200127, China
| | - Zhi-Feng Xi
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Engineering Research Centre of Transplantation and Immunology, Shanghai 200127, China
| | - Mureo Kasahara
- Transplantation Center, National Center for Child Health and Development, Tokyo 157-8535, Japan
| | - Qiang Xia
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Engineering Research Centre of Transplantation and Immunology, Shanghai 200127, China; Shanghai Institute of Transplantation, Shanghai 200127, China.
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12
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Lau NSM, Henderson P. Outcomes of paediatric patients with chronic liver disease in early adulthood: A heterogeneous, but representative, regional cohort study. J Paediatr Child Health 2022; 58:1771-1777. [PMID: 35762110 PMCID: PMC9796537 DOI: 10.1111/jpc.16091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/26/2022] [Accepted: 05/22/2022] [Indexed: 01/01/2023]
Abstract
AIM Advances in paediatric hepatology have led to the increasing survival of patients with paediatric-onset chronic hepatobiliary disease into adulthood. Data are lacking with regard to the outcomes of this heterogeneous group of patients and current transition models may be insufficient. This retrospective regional cohort study examined the outcomes of these patients cared for in a paediatric gastroenterology centre following transfer to adult services. METHODS A prospective database of paediatric patients with liver disease identified those already transferred to adult services. Following exclusions, medical notes were examined and health parameters recorded including initial diagnoses, transplant status, fertility and mortality. Descriptive statistics were used to calculate follow-up data and transplant-free survival (TFS). RESULTS Overall, 63 patients (52% male) entered the final analyses with a median follow-up of 27.5 years. The most common diagnosis was biliary atresia (19%); 27 different diagnoses were apparent within the cohort highlighting the heterogeneity within a single centre. Transplant prevalence at adult transfer was 41%; 14% of patients were lost to follow-up including 10% of transplant patients. TFS for biliary atresia was 17% after 37.4 years follow-up and was 54% for the total cohort. There were seven documented pregnancies and the prevalence of any psychological or psychiatric input was 44%. Transplant complications occurred in 38% of patients; there were two cancer diagnoses and two deaths following transfer. CONCLUSIONS Although overall mortality was low, the health-care burden of patients with paediatric-onset chronic liver disease is high. This group is also very heterogeneous, making structured transition to adult services difficult.
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Affiliation(s)
- Nicole SM Lau
- Child Life and HealthUniversity of EdinburghEdinburghUnited Kingdom
| | - Paul Henderson
- Child Life and HealthUniversity of EdinburghEdinburghUnited Kingdom,Department of Paediatric Gastroenterology and NutritionRoyal Hospital for Children and Young PeopleEdinburghUnited Kingdom
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13
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Direct-Acting Antivirals for HCV Treatment in Decompensated Liver Cirrhosis Patients: A Systematic Review and Meta-Analysis. J Pers Med 2022; 12:jpm12091517. [PMID: 36143302 PMCID: PMC9506163 DOI: 10.3390/jpm12091517] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022] Open
Abstract
DAA therapy is known to clear hepatitis C virus infection in patients with decompensated cirrhosis (DC). However, the safety and benefits of DAA in DC remain unclear, especially with the use of protease inhibitors (PI). Therefore, we evaluated the efficacy and clinical safety of DAA in DC patients and observed whether there was a discrepancy between PI-based and non-PI-based treatment. We searched Ovid-Medline, Ovid-EMBASE, Cochrane Library, and three local medical databases through October 2021 to identify relevant studies on the clinical safety and effectiveness of DAA in DC patients. The outcomes were sustained virologic response (SVR), overall mortality, the incidence rate of hepatocellular carcinoma (HCC), adverse events, improvement or deterioration of liver function, and delisting from liver transplantation (LT). Two independent reviewers extracted the data from each study using a standardized form. The pooled event rate in DC patients and relative effect (odds ratio (OR)) of PI-treated versus non-PI-based DAA in DC patients were calculated using a random-effects model. In patients with DC, the SVR rate was 86% (95% CI 83–88%), the development of HCC 7% (95% CI 5–9%), and mortality 6% (95% CI 4–8%). Improvement in liver function was observed in 51% (95% CI 44–58%) of patients, and 16% (95% CI 5–40%) were delisted from LT. PI-based treatment showed a similar rate of serious adverse events (23% vs. 18%), HCC occurrence (5% vs. 7%), and mortality (5% vs. 6%) to that of non-PI-based DAA treatment in DC patients. HCC occurrence and mortality rates were low in patients with DC following DAA treatment. PI-based treatment in DC patients was relatively safe when compared to non-PI-based treatment. Overall, DAA improved liver function, which may have allowed for delisting from LT.
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14
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Mataya L, Bittermann T, Quarshie WO, Griffis H, Srinivasan V, Rand EB, Alcamo AM. Status 1B designation does not adequately prioritize children with acute-on-chronic liver failure for liver transplantation. Liver Transpl 2022; 28:1288-1298. [PMID: 35188336 DOI: 10.1002/lt.26436] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/25/2022] [Accepted: 02/14/2022] [Indexed: 02/07/2023]
Abstract
Acute-on-chronic liver failure (ACLF) is an acute decompensation of chronic liver disease leading to multiorgan failure and mortality. The objective of this study was to evaluate characteristics and outcomes of children with ACLF who are at the highest priority for liver transplantation (LT) on the United Network for Organ Sharing (UNOS) database-listed as status 1B. The characteristics and outcomes of 478 children with ACLF listed as status 1B on the UNOS LT waiting list from 2007-2019 were compared with children with similar or higher priority listing for transplant: 929 with acute liver failure (ALF) listed as status 1A and 808 with metabolic diseases and malignancies listed as status 1B (termed "non-ACLF"). Children with ACLF had comparable rates of cumulative organ failures compared with ALF (45% vs. 44%; p > 0.99) listings, but higher than non-ACLF (45% vs. 1%; p < 0.001). ACLF had the lowest LT rate (79%, 84%, 95%; p < 0.001), highest pre-LT mortality (20%, 11%, 1%; p < 0.001), and longest waitlist time (57, 3, 56 days; p < 0.001), and none recovered without LT (0%, 4%, 1%; p < 0.001). In survival analyses, ACLF was associated with an increased adjusted hazard ratio (HR) for post-LT mortality (HR, 1.50 vs. ALF [95% confidence interval, CI, 1.02-2.19; p = 0.04] and HR, 1.64 vs. non-ACLF [95% CI, 1.15-2.34; p = 0.01]). ACLF has the least favorable waitlist and post-LT outcomes of all patients who are status 1A/1B. Increased prioritization on the LT waiting list may offer children with ACLF an opportunity for enhanced outcomes.
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Affiliation(s)
- Leslie Mataya
- Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Therese Bittermann
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - William O Quarshie
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Heather Griffis
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Vijay Srinivasan
- Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elizabeth B Rand
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alicia M Alcamo
- Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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15
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Abstract
Liver transplantation (LT) for children results in excellent short- and long-term patient and graft survival. LT is a lifesaving procedure in children with acute or chronic liver disease, hepatic tumors, and select genetic metabolic diseases in which it can significantly improve quality of life. In this article, the authors discuss the unique aspects of pediatric LT, including the indications, appropriate patient selection and evaluation, allocation of organs, transplant surgery including the use of variant grafts, posttransplant care including immunosuppression management, prognosis, and transition of care.
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Affiliation(s)
- Sara Kathryn Smith
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Johns Hopkins School of Medicine, 600 N Wolfe Street, Baltimore, MD 21287, USA.
| | - Tamir Miloh
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Miami, Highland Professional Building, 1801 Northwest 9th Avenue, Miami, FL 33136, USA
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16
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Gad EH, Sallam AN, Soliman H, Ibrahim T, Salem TAH, Ali MAH, Al-Sayed Abd-same M, Ayoub I. Pediatric living donor liver transplantation (LDLT): Short- and long-term outcomes during sixteen years period at a single centre- A retrospective cohort study. Ann Med Surg (Lond) 2022; 79:103938. [PMID: 35860167 PMCID: PMC9289343 DOI: 10.1016/j.amsu.2022.103938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 02/05/2023] Open
Abstract
Background and objectives Pediatric living donor liver transplantation (LDLT) is an effective tool for managing pediatric patients with end-stage liver disease (ESLD) with good long-term graft and patient survival, especially after improvement in peri-operative care, surgical tools and techniques; however, the morbidity and mortality after such a procedure are still a challenging matter. The study aimed to analyze short-and long-term outcomes after pediatric LDLT in a single centre. Methods We retrospectively analyzed 67 pediatric patients who underwent LDLT in the period from April 2003 to July 2018. The overall male/female ratio was 40/27. Results Forty-one (61.2%) of patients had ≥1 early and/or late morbidities; the early (less than 3months) and late (≥3months) ones affected 36(53.7%) and 12(17.9%) of them respectively. The 16-year graft and patient survivals were 35(52.2%) while early and late mortalities were 23(34.3%) and 9(13.4%) respectively. Sepsis and chronic rejection were the most frequent causes of early and late mortalities respectively. Moreover, more packed RBCs transfusion units, bacterial infections, and pulmonary complications were independent predictors of poor patient survival. Conclusions More packed RBCs transfusion units intra-operatively, and post-liver transplant (LT) bacterial infection, sepsis, chronic rejection, as well as pulmonary complications had a negative insult on our patients' outcomes, so proper management of them is mandatory for improving outcomes after pediatric LDLT. More packed RBCs transfusion units intra-operatively had a negative insult on outcomes after paediatric LDLT. Bacterial infection and pulmonary complications led to poor outcomes after paediatric LDLT. Sepsis and chronic rejection led to post paediatric LDLT poor patient outcomes.
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Affiliation(s)
- Emad Hamdy Gad
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt
- Corresponding author..
| | - Ahmed Nabil Sallam
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt
| | - Hosam Soliman
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt
| | - Tarek Ibrahim
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt
| | | | | | | | - Islam Ayoub
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt
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17
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Squires JE, Demetris AJ. Surveillance Biopsies in Pediatric Liver Transplantation: Is the Juice Worth the Squeeze? Liver Transpl 2022; 28:754-755. [PMID: 35092345 DOI: 10.1002/lt.26420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 01/13/2023]
Affiliation(s)
- James E Squires
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA
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18
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Dalzell C, Vargas PA, Soltys K, Dipaola F, Mazariegos G, Oberholzer J, Goldaracena N. Living Donor Liver Transplantation vs. Split Liver Transplantation Using Left Lateral Segment Grafts in Pediatric Recipients: An Analysis of the UNOS Database. Transpl Int 2022; 36:10437. [PMID: 35391900 PMCID: PMC8980223 DOI: 10.3389/ti.2022.10437] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/03/2022] [Indexed: 12/12/2022]
Abstract
Split and LDLT in pediatric patients have the potential to decrease wait times and waitlist mortality. Using UNOS-STAR data, we compared outcomes of pediatric patients undergoing LDLT and SLT using LLS grafts. The baseline characteristics and post-operative outcomes were compared between groups. Actuarial graft and patient survival were analyzed with Kaplan-Meier curves. Between 2010 and 2019, 911 pediatric LT were included in the analysis (LD graft group, n = 508, split graft group, n = 403). LD graft recipients spent more time on the waitlist vs. the split graft group (60 (22–138) days vs. 46 (16–108) days; p = 0.007). LD recipients had a lower rate of graft failure, found in 9.8% of patients compared with 14.6% in the split graft group (p = 0.02). HAT was the most common graft failure cause, with similar rates. Graft and patient survival at 1-, 3-, and 5-years was comparable between LDLT and SLT. In subgroup analyses, patients with biliary atresia, those ≤10 kg or ≤10 years old receiving an LD graft showed improved graft survival. In conclusion, LDLT is associated with a lower rate of graft failure in pediatric patients. The use of LLS regardless of the type of donor is a safe way to facilitate access to transplantation to pediatric patients with acceptable short and long-term outcomes.
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Affiliation(s)
- Christina Dalzell
- School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Paola A Vargas
- Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Kyle Soltys
- Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA, United States.,Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh and Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Frank Dipaola
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Virginia, Charlottesville, VA, United States
| | - George Mazariegos
- Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA, United States.,Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh and Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Jose Oberholzer
- Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Nicolas Goldaracena
- Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA, United States
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19
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Prachuapthunyachart S, Sintusek P, Tubjareon C, Chaijitraruch N, Sanpavat A, Phewplung T, Wanawongsawad P, Intrarakamhang AL, Chongsrisawat V. Pediatric liver transplantation outcomes from a single center in Thailand. World J Hepatol 2022; 14:583-591. [PMID: 35582298 PMCID: PMC9055198 DOI: 10.4254/wjh.v14.i3.583] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/31/2021] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver transplantation (LT) has become an acceptable curative method for children with several liver diseases, especially irreversible acute liver failure and chronic liver diseases. King Chulalongkorn Memorial Hospital is one of Thailand’s largest liver transplant centers and is responsible for many pediatric cases.
AIM To report the experience with pediatric LT and evaluate outcomes of living-related vs deceased-donor grafts.
METHODS This evaluation included children who underwent LT between August 2004 and November 2019. Data were retrospectively reviewed, including demographics, diagnoses, laboratory values of donors and recipients, the pediatric end-stage liver disease (PELD) or model for end-stage liver disease (MELD) score, graft source, wait time, perioperative course, postoperative complications, and survival rates. Continuous data were reported using the median and interquartile range. The Mann–Whitney U-test was used to compare the wait time between the living-related and deceased-donor groups. The chi-square or Fisher's exact test were used to compare the frequencies of between-group complications. Survival rates were calculated using the Kaplan–Meier method.
RESULTS Ninety-four operated pediatric liver transplant patients were identified (54% were females). The median age at transplantation was 1.2 (0.8-3.8) years. The median PELD and MELD scores were 20 (13-26.8) and 19.5 (15.8-26.3), respectively. Most grafts (81.9%) were obtained from living-related donors. The median wait time for the living donors was significantly shorter compared with the deceased donors at 1.6 (0.3-3.1) mo vs 11.2 (2.1-33.3) mo (P = 0.01). Most patients were diagnosed with biliary atresia (74.5%), and infection was the most common complication within 30 d post-transplantation (14.9%). Without a desensitization protocol, 9% of transplants were ABO-incompatible. Eight hepatitis B core antibodies (anti-HBc)-negative recipients received positive anti-HBc grafts without different observed complications. The overall survival rate was 93.6% and 90.3% at 1 and 5 years, respectively. No graft loss during follow-up was noted among survivors.
CONCLUSION A significant number of pediatric LT cases were reported in Thailand. Based on relatively comparable outcomes, ABO-incompatible and HBc antibody-positive grafts may be considered in an organ shortage situation.
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Affiliation(s)
- Sittichoke Prachuapthunyachart
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Palittiya Sintusek
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
- Thai Pediatric Gastroenterology, Hepatology and Immunology Research Unit, Department of Pediatrics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross, Chulalongkorn University, Bangkok 10330, Thailand
| | - Chomchanat Tubjareon
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Nataruks Chaijitraruch
- Excellence Center of Organ Transplantation, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Anapat Sanpavat
- Department of Pathology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Teerasak Phewplung
- Department of Radiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Piyaporn Wanawongsawad
- Excellence Center of Organ Transplantation, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Ai-lada Intrarakamhang
- Excellence Center of Organ Transplantation, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Voranush Chongsrisawat
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
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20
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Over 30 Years of Pediatric Liver Transplantation at the Charité-Universitätsmedizin Berlin. J Clin Med 2022; 11:jcm11040900. [PMID: 35207173 PMCID: PMC8880346 DOI: 10.3390/jcm11040900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 12/11/2022] Open
Abstract
Background: Pediatric liver transplantation (LT) is the treatment of choice for children with end-stage liver disease and in certain cases of hepatic malignancies. Due to low case numbers, a technically demanding procedure, the need for highly specialized perioperative intensive care, and immunological, as well as infectious, challenges, the highest level of interdisciplinary cooperation is required. The aim of our study was to analyze short- and long-term outcomes of pediatric LT in our center. Methods: We conducted a retrospective single-center analysis of all liver transplantations in pediatric patients (≤16 years) performed at the Department of Surgery, Charité – Universitätsmedizin Berlin between 1991 and 2021. Three historic cohorts (1991–2004, 2005–2014 and 2015–2021) were defined. Graft- and patient survival, as well as perioperative parameters were analyzed. The study was approved by the institutional ethics board. Results: Over the course of the 30-year study period, 212 pediatric LTs were performed at our center. The median patient age was 2 years (IQR 11 years). Gender was equally distributed (52% female patients). The main indications for liver transplantation were biliary atresia (34%), acute hepatic necrosis (27%) and metabolic diseases (13%). The rate of living donor LT was 25%. The median cold ischemia time for donation after brain death (DBD) LT was 9 h and 33 min (IQR 3 h and 46 min). The overall donor age was 15 years for DBD donors and 32 years for living donors. Overall, respective 1, 5, 10 and 30-year patient and graft survivals were 86%, 82%, 78% and 65%, and 78%, 74%, 69% and 55%. One-year patient survival was 85%, 84% and 93% in the first, second and third cohort, respectively (p = 0.14). The overall re-transplantation rate was 12% (n = 26), with 5 patients (2%) requiring re-transplantation within the first 30 days. Conclusion: The excellent long-term survival over 30 years showcases the effectiveness of liver transplantation in pediatric patients. Despite a decrease in DBD organ donation, patient survival improved, attributed, besides refinements in surgical technique, mainly to improved interdisciplinary collaboration and management of perioperative complications.
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21
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Alnagar A, Daradka K, Kyrana E, Mtegha M, Palaniswamy K, Rajwal S, Mulla J, O'meara M, Karam M, Shawky A, Hakeem AR, Upasani V, Dhakshinamoorthy V, Prasad R, Attia M. Predictors of patient and graft survival following pediatric liver transplantation: Long-term analysis of more than 300 cases from single centre. Pediatr Transplant 2022; 26:e14139. [PMID: 34545678 DOI: 10.1111/petr.14139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/04/2021] [Accepted: 08/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pediatric liver transplant (PLT) activity has flourished over time although with limited expansion in the graft pool. The study aims to identify pre-transplant factors that predict post-transplant patient and graft survival in the PLT population. METHODS Retrospective review of PLTs at a single tertiary transplant unit from 2000 to 2019. Univariate and multivariate analyses of pre-transplant factors were performed to identify predictors of patient and graft survival. RESULTS Two hundred and seventy-six patients received 320 PLTs. The most common cause of graft loss was hepatic artery thrombosis (n = 13, 29.6%). The most common cause of mortality was sepsis (n = 11, 29.7%). Univariate analysis showed that the following variables had a significant (p < .05) impact on patient survival: recipient age, weight, height, graft type (technical variant graft), transplant category (acute liver failure), the era of transplant, and invasive ventilation. The following variables had a significant (p < .05) impact on graft survival: recipient age, weight, height, transplant category (acute liver failure), and the era of transplant. Multivariate analysis precluded the era of transplant as the only significant factor for patient survival; patients transplanted after 2005 had significantly higher patient survival. No independent factor predicting graft survival was identified. For children transplanted after 2005, the only factor that predicted patient survival was pre-transplant invasive ventilation. CONCLUSIONS Our study suggests that the learning curve and pre-transplant invasive ventilation in the recipient have a significant impact on patient survival. The traditional view of worse outcomes of smaller PLT candidates should be changed.
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Affiliation(s)
- Amr Alnagar
- The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds, UK.,General Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Khaled Daradka
- The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds, UK.,Department of General Surgery, Jordan University Hospital, The University of Jordan- Queen Rania Street, Amman, Jordan
| | - Eirini Kyrana
- The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds, UK
| | - Marumbo Mtegha
- The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds, UK
| | | | - Sanjay Rajwal
- The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds, UK
| | - Jamila Mulla
- The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds, UK
| | - Moira O'meara
- The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds, UK
| | - Mohamed Karam
- General Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Shawky
- General Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Vivek Upasani
- The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds, UK
| | | | - Raj Prasad
- The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds, UK
| | - Magdy Attia
- The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds, UK
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22
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Farkas-Skiles CM, Ettenger RB, Zuckerman JE, Pearl M, Venick RS, Weng PL. De novo lupus-like glomerulonephritis after pediatric non-kidney organ transplantation. Pediatr Nephrol 2022; 37:153-161. [PMID: 34292379 PMCID: PMC8674157 DOI: 10.1007/s00467-021-05194-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND We propose a novel clinically significant finding, de novo lupus-like glomerulonephritis (DNLLGN), in patients with autoantibodies and kidney abnormalities in pediatric liver transplant (LT) and intestinal inclusive transplants (ITx). METHODS We describe the clinical, serologic, and histopathologic presentation and kidney outcomes in eight patients from our center found to have DNLLGN on kidney biopsy. RESULTS Pediatric recipients of non-kidney solid organ transplants developed an unusual de novo immune complex glomerulonephritis with morphologic similarity to lupus nephritis. Six had isolated LT (0.9% of all pediatric LT at our center) and two had ITx (2.1% of all ITx). Five (63%) presented with nephrotic syndrome. Five patients had autoantibodies. Patients underwent kidney biopsy at a mean of 11.5 years in LT and 2.8 years in ITx after the index transplant. Biopsies demonstrated changes similar to focal or diffuse active lupus. Follow-up eGFR at a mean of 6 years after biopsy showed a mean decrease of 30 ml/min/1.73 m2 in all patients (p = 0.11). CONCLUSIONS DNLLGN has not been previously recognized in this clinical setting, yet 8 kidney biopsies from pediatric recipients of LT and ITx at our center in 25 years demonstrated this finding. DNLLGN appears to be an under-reported phenomenon of clinical significance. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Cristina M. Farkas-Skiles
- Department of Pediatrics, Division of Nephrology, University of California Los Angeles Medical Center, Los Angeles, CA USA
| | - Robert B. Ettenger
- Department of Pediatrics, Division of Nephrology, University of California Los Angeles Medical Center, Los Angeles, CA USA
| | - Jonathan E. Zuckerman
- Department of Pathology, University of California Los Angeles Medical Center, Los Angeles, CA USA
| | - Meghan Pearl
- Department of Pediatrics, Division of Nephrology, University of California Los Angeles Medical Center, Los Angeles, CA USA
| | - Robert S. Venick
- Department of Pediatrics, Division of Gastroenterology, University of California Los Angeles Medical Center, Los Angeles, CA USA
| | - Patricia L. Weng
- Department of Pediatrics, Division of Nephrology, University of California Los Angeles Medical Center, Los Angeles, CA USA
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23
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Ziogas IA, Wu WK, Matsuoka LK, Pai AK, Hafberg ET, Gillis LA, Morgan TM, Alexopoulos SP. Liver Transplantation in Children with Urea Cycle Disorders: The Importance of Minimizing Waiting Time. Liver Transpl 2021; 27:1799-1810. [PMID: 34058057 PMCID: PMC9291867 DOI: 10.1002/lt.26186] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/28/2021] [Accepted: 05/10/2021] [Indexed: 12/14/2022]
Abstract
Liver transplantation (LT) for children with urea cycle disorders (UCDs) is capable of correcting the enzymatic defect and preventing progressive neurologic injury. We describe the characteristics and outcomes of pediatric LT recipients with UCDs. We identified all pediatric (<18 years) LT candidates with UCDs in the United Network for Organ Sharing (UNOS) database (February 2002 to September 2020). Multivariable Cox and logistic regression were used to determine risk factors for graft loss and cognitive delay, respectively. Of 424 patients, 1.9% (8/424) experienced waitlist mortality and 95.0% underwent LT (403/424). The most frequently encountered UCDs in our cohort were ornithine transcarbamylase deficiency (46.2%), citrullinemia (20.3%), and argininosuccinic aciduria (ASA; 12.9%). The 1-, 3-, and 5-year graft survival rates were 90.4%, 86.3%, and 85.2%, respectively. Multivariable analysis showed a decreased risk of graft loss with increasing weight at LT (adjusted hazard ratio [aHR], 0.96; 95% confidence interval [CI], 0.94-0.99; P = 0.02), male sex (aHR, 0.49; 95% CI, 0.28-0.85; P = 0.01), and ASA diagnosis (aHR, 0.29; 95% CI, 0.09-0.98; P = 0.047), when adjusting for location (intensive care/hospital/home) and graft type (both P ≥ 0.65). In multivariable logistic regression, waitlist time (adjusted odds ratio [aOR], 1.10; 95% CI, 1.02-1.17; P = 0.009) and male sex (aOR, 1.71; 95% CI, 1.02-2.88; P = 0.04) were associated with increased odds of long-term cognitive delay. Waitlist duration is associated with a long-term risk of cognitive delay. Given excellent long-term outcomes, early LT evaluation should be considered in all children with UCDs to prevent progressive neurologic injury and optimize cognitive outcomes.
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Affiliation(s)
- Ioannis A. Ziogas
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of SurgeryVanderbilt University Medical CenterNashvilleTN
| | - W. Kelly Wu
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of SurgeryVanderbilt University Medical CenterNashvilleTN
| | - Lea K. Matsuoka
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of SurgeryVanderbilt University Medical CenterNashvilleTN
| | - Anita K. Pai
- D. Brent Polk Division of Gastroenterology, Hepatology, and NutritionDepartment of PediatricsVanderbilt University Medical CenterNashvilleTN
| | - Einar T. Hafberg
- D. Brent Polk Division of Gastroenterology, Hepatology, and NutritionDepartment of PediatricsVanderbilt University Medical CenterNashvilleTN
| | - Lynette A. Gillis
- D. Brent Polk Division of Gastroenterology, Hepatology, and NutritionDepartment of PediatricsVanderbilt University Medical CenterNashvilleTN
| | - Thomas M. Morgan
- Division of Medical GeneticsDepartment of PediatricsVanderbilt University Medical CenterNashvilleTN
| | - Sophoclis P. Alexopoulos
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of SurgeryVanderbilt University Medical CenterNashvilleTN
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24
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Yan KL, Gomes AS, Monteleone PA, Venick RS, McDiarmid SV, Vargas JH, Farmer DG. Management of Biliary Stricture in Pediatric Liver Transplantation Patients: Long-Term Outcomes. Liver Transpl 2021; 27:1788-1798. [PMID: 33977642 DOI: 10.1002/lt.26095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 01/13/2023]
Abstract
Postoperative biliary complications have been reported to occur in 10% to 33% of pediatric liver transplantation (LT) recipients. Percutaneous intervention has become the primary treatment method for these complications; however, the efficacy and outcomes of these patients have not been well studied. Institutional pediatric LT from 1998 to 2019 were retrospectively reviewed to determine the patients referred for percutaneous treatment of post-LT biliary strictures. Clinical parameters, percutaneous transhepatic cholangiograms (PTCs), biliary catheter placement, cholangioplasty, and long-term outcomes were analyzed. Of the 396 consecutive pediatric LT recipients during our study period, 50 (12.6%) were diagnosed with biliary strictures on PTC. LT biliary reconstructions were Roux-en-Y hepaticojejunostomy in 28 patients (56%), choledochojejunostomy in 11 patients (22%), and choledochocholedochostomy in 11 patients (22%). Median age at LT was 23.2 months (interquartile range [IQR], 10.9-90.6), and 14 patients (28%) developed hepatic artery thrombosis. A total of 44 patients (88%) were treated with internal/external biliary catheters, of whom 38 (76%) underwent balloon cholangioplasty. By 12 months, 84% of patients had complete stricture resolution and catheter removal. Median total duration of catheter drainage was 152 days (IQR, 76-308). A total of 8 patients required additional surgery (biliary reconstruction or repeat LT [re-LT]) or died with a drainage catheter in place from complications unrelated to PTC intervention. Among the 6 patients (12%) treated with unilateral external biliary drainage catheters, 2 had catheters removed for inadequate drainage but then had spontaneous biliary obstruction resolution, 1 underwent duct reconstruction, and 3 required long-term catheterization. Biliary strictures following pediatric LT can be successfully treated with internal/external biliary drainage catheters and cholangioplasty if the stricture can be crossed. However, patients with isolated strictured ducts may require long-term external catheter drainage until re-LT or percutaneous obliteration of isolated ducts.
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Affiliation(s)
- Kimberly L Yan
- School of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA
| | - Antoinette S Gomes
- School of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA.,Department of Radiological Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles
| | - Phillip A Monteleone
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles
| | - Robert S Venick
- Department of Pediatric Gastroenterology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA
| | - Sue V McDiarmid
- Department of Pediatric Gastroenterology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA
| | - Jorge H Vargas
- Department of Pediatric Gastroenterology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA
| | - Douglas G Farmer
- Department of Surgery, Liver Transplantation, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA
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25
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Couper MR, Shun A, Siew S, O'Loughlin E, Thomas G, Andersen B, Jermyn V, Sawyer J, Stormon MO. Pediatric third liver transplantation-A single-center experience. Pediatr Transplant 2021; 25:e14092. [PMID: 34313365 DOI: 10.1111/petr.14092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/31/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pediatric retransplantation is an accepted practice for graft failure and complications in Australasia. As 15% of children require a third transplant, this is a growing cohort with limited data in the literature. METHODS We review nine patients from the commencement of our transplantation program in 1986 up to 2020 assessing demographics, prognosis, and outcome measures. RESULTS Third transplant patient survival was comparative to first and second transplant patient survival at 5 years. All deaths were within the post-operative period and secondary to sepsis. Operative times and transfusion volumes were increased at third transplant (1.8 and 4.5 times compared to first transplant, respectively). Learning difficulties and psychological disturbances were prevalent (83% and 66.6%, respectively). CONCLUSIONS While recent mortality outcomes appear comparable to undergoing a second liver transplant, third transplant operations were more complex. Neurological impairment and psychological disturbance appear to be prevalent and need to be considered in pre-transplant counseling.
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Affiliation(s)
- Michael R Couper
- Department of Gastroenterology, Children's Hospital at Westmead, Westmead, NSW, Australia.,Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Albert Shun
- Department of Gastroenterology, Children's Hospital at Westmead, Westmead, NSW, Australia.,Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Susan Siew
- Department of Gastroenterology, Children's Hospital at Westmead, Westmead, NSW, Australia.,Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Edward O'Loughlin
- Department of Gastroenterology, Children's Hospital at Westmead, Westmead, NSW, Australia.,Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Gordon Thomas
- Department of Gastroenterology, Children's Hospital at Westmead, Westmead, NSW, Australia.,Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Brooke Andersen
- Department of Gastroenterology, Children's Hospital at Westmead, Westmead, NSW, Australia.,Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Vicki Jermyn
- Department of Gastroenterology, Children's Hospital at Westmead, Westmead, NSW, Australia.,Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Janine Sawyer
- Department of Gastroenterology, Children's Hospital at Westmead, Westmead, NSW, Australia.,Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael O Stormon
- Department of Gastroenterology, Children's Hospital at Westmead, Westmead, NSW, Australia.,Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia
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26
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Boillot O, Guillaud O, Pittau G, Rivet C, Boucaud C, Lachaux A, Dumortier J. Determinants of short-term outcomes after pediatric liver transplantation: a single centre experience over 20 years. Clin Res Hepatol Gastroenterol 2021; 45:101565. [PMID: 33250362 DOI: 10.1016/j.clinre.2020.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Liver transplantation (LT) is a standard-of-care therapeutic modality for selected patients with life-threatening liver disease, including children. In addition to specific clinical characteristics of pediatric LT recipients due to initial liver disease (and related comorbidities) and level of liver failure, early postoperative outcome may be dependent on the surgical technique used, related to the type of organ donor and graft. Therefore, the aims of the present retrospective study from a large single centre cohort were to identify the prognostic factors for both 1-year patient and graft survival. METHODS Between October 1990 and October 2010, 151 children underwent a first LT in our centre. RESULTS The mean age was 5.3 ± 7.4 years, and the main indication was biliary atresia (BA) (49.0%). Living donor liver transplantation (LDLT) was performed in 39 cases (25.8%). Cadaveric liver graft was a whole liver in 50 cases (33.1%) and a partial liver (reduced or split) in 62 cases (41.1%). One-year patient and graft survival rates were 88.7% and 86.1%, respectively. Multivariate analysis disclosed that initial liver disease, location at time of LT, donor/recipient (D/R) delta age, early post-transplant hemodialysis and initial immunosuppression (induction) were significantly associated with patient survival and that D/R delta age, primary non-function, early post-transplant hemodialysis and initial immunosuppression (induction) were significantly associated with graft survival. CONCLUSION The results of our single-centre experience of pediatric LT emphasize that early patient and graft survivals depend on pre-operative/operative factors such as initial liver disease, D/R delta age and immunosuppressive regimen. Awareness of these factors can help in the decision making for children requiring LT.
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Affiliation(s)
- Olivier Boillot
- Department of Digestive Diseases, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; University Claude Bernard Lyon 1, Lyon, France
| | - Olivier Guillaud
- Department of Digestive Diseases, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; Ramsay Générale de Santé, Clinique de la Sauvegarde, Lyon, France
| | - Gabriella Pittau
- Department of Digestive Diseases, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Christine Rivet
- Department of Pediatric Hepatogastroenterology and Nutrition, and Centre National de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, Lyon, France
| | - Catherine Boucaud
- Department of Anesthesiology, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, Lyon, France
| | - Alain Lachaux
- University Claude Bernard Lyon 1, Lyon, France; Department of Pediatric Hepatogastroenterology and Nutrition, and Centre National de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Dumortier
- Department of Digestive Diseases, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; University Claude Bernard Lyon 1, Lyon, France.
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27
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Vimalesvaran S, Dhawan A. Liver transplantation for pediatric inherited metabolic liver diseases. World J Hepatol 2021; 13:1351-1366. [PMID: 34786171 PMCID: PMC8568579 DOI: 10.4254/wjh.v13.i10.1351] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/23/2021] [Accepted: 08/20/2021] [Indexed: 02/06/2023] Open
Abstract
Liver transplantation (LT) remains the gold standard treatment for end stage liver disease in the pediatric population. For liver based metabolic disorders (LBMDs), the decision for LT is predicated on a different set of paradigms. With improved outcomes post-transplantation, LT is no longer merely life saving, but has the potential to also significantly improve quality of life. This review summarizes the clinical presentation, medical treatment and indications for LT for some of the common LBMDs. We also provide a practical update on the dilemmas and controversies surrounding the indications for transplantation, surgical considerations and prognosis and long terms outcomes for pediatric LT in LBMDs. Important progress has been made in understanding these diseases in recent years and with that we outline some of the new therapies that have emerged.
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Affiliation(s)
- Sunitha Vimalesvaran
- Paediatric Liver GI and Nutrition Center, King's College Hospital, London SE5 9RS, United Kingdom
| | - Anil Dhawan
- Paediatric Liver GI and Nutrition Center, King's College Hospital, London SE5 9RS, United Kingdom
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28
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Zakaria HM, Alobthani S, Elsarawy A, Saleh Y, Zidan A, Alabbad S, Elsheikh Y, Algoufi T, Shagrani M, Troisi RI, Broering D. Large for size in pediatrics liver transplant using left lateral segment grafts: A single center experience. Pediatr Transplant 2021; 25:e14044. [PMID: 34076330 DOI: 10.1111/petr.14044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/01/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND There are still controversies in using the large left lateral segment in pediatrics LT, with the possibility of the problem of LFS grafts, and the use of monosegmental or reduced liver grafts in small infants. This study aimed to evaluate our experience with LFSG in pediatrics LT. METHODS A cohort retrospective analysis was conducted including pediatric recipients who underwent LT between January 2011 and October 2019. We compared recipients with GRWR ≥ 4% (LFS) vs GRWR < 4% as an average for size grafts. RESULTS There were 331 pediatric LT, 74 patients with GRWR ≥ 4%, and 257 patients with GRWR < 4%. In the group of LFS grafts, temporary abdominal closure by silicon patch was done in 39 patients (52.7%), 2 patients (2.7%) had postoperative HAT, 3 patients (4.1%) early PVT, 1 patient (1.3%) bile leak, and 3 patients (4.1%) had wound infection, with no significant difference in these complications between the 2 groups. In patients with LFS- grafts, the 1-, 3-, 5-, and 7-year patients survival rates were 94.6%, 91.7%, 91.7%, and 91.7%, respectively, while the survival rates in patients of the other group were 96.1%, 92.6%, 91.9%, and 91.9%, respectively, with no significant difference (p = .85). CONCLUSION Using LFS graft by left lateral segment in pediatric LT with potential delayed abdominal closure is a safe and feasible option with good outcomes and unnecessary need for graft reduction if performed by an experienced multidisciplinary team.
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Affiliation(s)
- Hazem Mohamed Zakaria
- Department of Hepatopancreatobiliary and Liver Transplant Surgery, National Liver Institute, Menoufia University, Shebin El-koom, Egypt.,Department of Liver and Small Bowel Transplantation & HPB Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Salah Alobthani
- Department of Liver and Small Bowel Transplantation & HPB Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed Elsarawy
- Department of Liver and Small Bowel Transplantation & HPB Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,Department of Oncosurgery, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Yahia Saleh
- Department of Liver and Small Bowel Transplantation & HPB Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed Zidan
- Department of Liver and Small Bowel Transplantation & HPB Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,Department of General Surgery, Assiut University, Assiut, Egypt
| | - Saleh Alabbad
- Department of Liver and Small Bowel Transplantation & HPB Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Yasser Elsheikh
- Department of Liver and Small Bowel Transplantation & HPB Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,Department of General Surgery, Fayoum University, Fayoum, Egypt
| | - Talal Algoufi
- Department of Pediatric Hepatology, Liver and Small Bowel Transplantation, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohammad Shagrani
- Department of Pediatric Hepatology, Liver and Small Bowel Transplantation, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Roberto Ivan Troisi
- Department of Liver and Small Bowel Transplantation & HPB Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Dieter Broering
- Department of Liver and Small Bowel Transplantation & HPB Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Leiskau C, Junge N, Pfister ED, Goldschmidt I, Mutschler F, Laue T, Ohlendorf J, Nasser H, Beneke J, Richter N, Vondran F, Baumann U. Recipient-Specific Risk Factors Impairing Patient and Graft Outcome after Pediatric Liver Transplantation-Analysis of 858 Transplantations in 38 Years. CHILDREN-BASEL 2021; 8:children8080641. [PMID: 34438532 PMCID: PMC8393592 DOI: 10.3390/children8080641] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 12/19/2022]
Abstract
(1) Background and Aim: Despite excellent long-term results in pediatric liver transplantation (pLTx), mortality and graft loss still are to be diminished. We aim to describe time-dependent changes and long-term outcome of a large single-center pLTx cohort and to identify independent recipient-related risk factors impairing patient and graft survival. (2) Methods: This is a retrospective single-center study analyzing all pediatric liver transplants from 1983–2020. Risk factors for mortality and graft loss were identified by univariable and multi-linear regression analysis. (3) Results: We analyzed 858 liver transplantations in 705 pediatric patients. Five-year patient/graft survival increased from 60.9%/48.0% (1983–1992) to 97.5%/86.5% (OR = 12.5; p < 0.0001/OR = 6.5; p < 0.0001) (2014–2020). Indications changed significantly over time, with a higher proportion of patients being transplanted for malignancies and metabolic disease and indications of PFIC and α1AT-deficiency declining. The era of transplantation (log7.378/9.657; p < 0.0001) and indication of acute liver failure (log = 1.944/2.667; HR = 2.015/1.772; p = 0.0114/0.002) impairs patient/graft survival significantly in the multivariate analysis. Furthermore, patient survival is worsened by re-transplantation (log = 1.755; HR = 1.744; p = 0.0176) and prolonged waiting times in high-urgency status (log = 2.588; HR = 1.073; p = 0.0026), whereas the indication of biliary atresia improved outcome (log = 1.502; HR = 0.575; p = 0.0315). Graft survival was additionally impaired by pre-existing portal vein thrombosis (log = 1.482; HR = 2.016; p = 0.0330). (4) Conclusions: Despite more complex indications, patient and graft survival after pLTx continue to improve.. Acute liver failure remains the indication with poorest outcome, and listing for high urgency liver transplantation should be considered carefully and early to keep waiting time on HU list short. Furthermore, pre-transplant portal vein thrombosis should be prevented whenever possible to improve graft survival.
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Affiliation(s)
- Christoph Leiskau
- Pediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany; (N.J.); (E.-D.P.); (I.G.); (F.M.); (T.L.); (J.O.); (H.N.); (U.B.)
- Pediatric Gastroenterology, Department of Pediatrics and Adolescent Medicine, University Medical Centre Göttingen, Georg August University Göttingen, 37073 Göttingen, Germany
- Correspondence: ; Tel.: +49-551-39-67019
| | - Norman Junge
- Pediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany; (N.J.); (E.-D.P.); (I.G.); (F.M.); (T.L.); (J.O.); (H.N.); (U.B.)
| | - Eva-Doreen Pfister
- Pediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany; (N.J.); (E.-D.P.); (I.G.); (F.M.); (T.L.); (J.O.); (H.N.); (U.B.)
| | - Imeke Goldschmidt
- Pediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany; (N.J.); (E.-D.P.); (I.G.); (F.M.); (T.L.); (J.O.); (H.N.); (U.B.)
| | - Frauke Mutschler
- Pediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany; (N.J.); (E.-D.P.); (I.G.); (F.M.); (T.L.); (J.O.); (H.N.); (U.B.)
| | - Tobias Laue
- Pediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany; (N.J.); (E.-D.P.); (I.G.); (F.M.); (T.L.); (J.O.); (H.N.); (U.B.)
| | - Johanna Ohlendorf
- Pediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany; (N.J.); (E.-D.P.); (I.G.); (F.M.); (T.L.); (J.O.); (H.N.); (U.B.)
| | - Hamoud Nasser
- Pediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany; (N.J.); (E.-D.P.); (I.G.); (F.M.); (T.L.); (J.O.); (H.N.); (U.B.)
| | - Jan Beneke
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Hannover Medical School, 30625 Hannover, Germany;
| | - Nicolas Richter
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany; (N.R.); (F.V.)
| | - Florian Vondran
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany; (N.R.); (F.V.)
| | - Ulrich Baumann
- Pediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany; (N.J.); (E.-D.P.); (I.G.); (F.M.); (T.L.); (J.O.); (H.N.); (U.B.)
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Extracorporeal Membrane Oxygenation in Pediatric Liver Transplantation: A Multicenter Linked Database Analysis and Systematic Review of the Literature. Transplantation 2021; 105:1539-1547. [PMID: 32804800 DOI: 10.1097/tp.0000000000003414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) can be used to maintain oxygen delivery and provide hemodynamic support in case of circulatory and respiratory failure. Although the role of ECMO has emerged in the setting of adult liver transplantation (LT), data in children are limited. We aimed to describe the characteristics and outcomes of children receiving ECMO support at the time of or following LT. METHODS All pediatric LT recipients (≤20 y) requiring ECMO support peri-/post-LT were identified from a linked Pediatric Health Information System/Scientific Registry of Transplant Recipients dataset (2002-2018). The Kaplan-Meier method and Cox regression analysis were used to assess post-ECMO survival. A systematic literature review was conducted in accordance with the PRISMA statement. RESULTS Thirty-four children required ECMO peri-/post-LT. The median time from LT to ECMO was 5 d (interquartile range, 0.0-12.3), and the median ECMO duration was 1 d (interquartile range, 1.0-6.3). Children started on ECMO within 1 d of LT exhibited superior survival compared with those started on ECMO later (P = 0.03). When adjusting for recipient weight, increasing time from LT to ECMO initiation was associated with increased risk of mortality (hazard ratio, 1.03; 95% confidence interval, 1.00-1.06; P = 0.049). Overall, 55.9% (n = 19 of 34) of the patients survived. Twenty-two children receiving ECMO in the peri-/post-LT period were systematically reviewed, and 15 of them survived (68.2%). CONCLUSIONS With an encouraging >55% patient survival at 6 mo, ECMO should be considered as a viable option in pediatric LT recipients with potentially reversible severe respiratory or cardiovascular failure refractory to conventional treatment.
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Özen J, Beime J, Brinkert F, Fischer L, Herden U, Grabhorn E. Short- and long-term results of liver transplantation according to age at transplant: a single-center experience of 351 children. Transpl Int 2021; 34:1251-1260. [PMID: 33772883 DOI: 10.1111/tri.13872] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 01/05/2021] [Accepted: 03/16/2021] [Indexed: 01/12/2023]
Abstract
Pediatric liver transplantation (PLT) has very good results at experienced transplant centers. However, there is still an ongoing discussion about inferior outcomes, especially in young infants. The aim of this retrospective study was to evaluate outcomes of infants compared to older recipients in a single center over 20 years. We conducted a retrospective study of children who received liver transplants at our center between 1991 and 2011. Only patients without other limiting organ involvement were included and compared according to age. The inclusion criteria were fulfilled by 351 patients (173 vs. 178). The most common indication in both groups was biliary atresia (82.1% vs. 49.4%). The 1-, 5-, and 10-year patient survivals were 93.8%/91.8%/91.1% and 93%/90.8%/90.1%, and the graft survivals were 90.4%/83.5%/79.6% and 89.4%/81.8%/77.5%, respectively. Complications such as postoperative bleeding, biliary complications, or perfusion impairment occurred more often in infants. Leading indications for retransplantation (vascular complications/primary nonfunction) and leading causes of death (sepsis/multiorgan failure) were the same in both groups. Significant predictors for patient loss were decade of transplantation, retransplantation, postoperative bleeding, and infections for infants. Predictors for graft loss were bowel perforation, arterial thrombosis, and age >12 months. Children can have excellent results, independent of age at PLT.
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Affiliation(s)
- Julia Özen
- Department of Pediatrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Beime
- Department of Pediatrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Brinkert
- Department of Pediatrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Fischer
- Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Herden
- Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Enke Grabhorn
- Department of Pediatrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Prusinskas B, Ohlsson S, Kathemann S, Pilic D, Kampmann K, Büscher R, Paul A, Pape L, Hoyer PF, Lainka E. Role of Tacrolimus C/D Ratio in the First Year After Pediatric Liver Transplantation. Front Pediatr 2021; 9:659608. [PMID: 34150686 PMCID: PMC8206534 DOI: 10.3389/fped.2021.659608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/27/2021] [Indexed: 12/17/2022] Open
Abstract
Background: The calcineurin inhibitor (CNI) tacrolimus (TAC) is a cornerstone agent in immunosuppressive therapy in pediatric liver transplantation (LTX). Adverse effects limit the use of CNI. In adults, calculating the individual TAC metabolism rate allows to estimate the transplant recipient's risk for therapy-associated complications. Methods: A retrospective, descriptive data analysis was performed in children who had undergone LTX in 2009-2017 and had received TAC twice daily in the first year after LTX. A weight-adjusted concentration/dose ratio (C/D ratio) was calculated [TAC trough level/(daily TAC dose/body weight)] every 3 months after LTX to estimate the average individual TAC metabolism rate. Depending on the C/D ratio, all patients were divided into two groups: fast metabolizers (FM) and slow metabolizers (SM). Clinical and laboratory parameters were analyzed as risk factors in both groups. Results: A total of 78 children (w 34, m 44, median age at LTX 2.4; 0.4-17.0 years) were enrolled in the study. FM (SM) had a mean C/D ratio of <51.83 (≥51.83) ng/ml/(mg/kg). FM were younger at the time of LTX (median age 1.7; 0.4-15.8 years) than SM (5.1, 0.4-17.0), p = 0.008. FM were more likely to have biliary atresia (20/39, 51%) compared to SM (11/39, 28%), p = 0.038, whereas SM were more likely to have progressive familial intrahepatic cholestasis (9/39, 23%) vs. in FM (1/39, 3%), p = 0.014. Epstein-Barr virus (EBV) infection occurred more frequently in FM (27/39, 69%) than SM (13/39, 33%), p = 0.002. Three FM developed post-transplant lymphoproliferative disorder. The annual change of renal function did not differ in both groups (slope FM 1.2 ± 0.6; SM 1.4 ± 0.8 ml/min/1.73 m2 per year, and p = 0.841). Conclusions: Calculation of individual, weight-adjusted TAC C/D ratio is a simple, effective, and cost-efficient tool for physicians to estimate the risk of therapy-associated complications and to initiate individual preventive adjustments after pediatric LTX. Lower TAC levels are tolerable in FM, especially in the presence of EBV infection, reduced renal function, or when receiving a liver transplant in the first 2 years of life.
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Affiliation(s)
- Benas Prusinskas
- Department of Pediatrics II, Pediatric Gastroenterology, Hepatology and Liver Transplantation, University Children's Hospital, Essen, Germany
| | - Sinja Ohlsson
- Department of Pediatrics II, Pediatric Gastroenterology, Hepatology and Liver Transplantation, University Children's Hospital, Essen, Germany
| | - Simone Kathemann
- Department of Pediatrics II, Pediatric Gastroenterology, Hepatology and Liver Transplantation, University Children's Hospital, Essen, Germany
| | - Denisa Pilic
- Department of Pediatrics II, Pediatric Gastroenterology, Hepatology and Liver Transplantation, University Children's Hospital, Essen, Germany
| | - Kristina Kampmann
- Department of Pediatrics II, Pediatric Gastroenterology, Hepatology and Liver Transplantation, University Children's Hospital, Essen, Germany
| | - Rainer Büscher
- Department of Pediatrics II, Pediatric Nephrology and Kidney Transplantation, University Children's Hospital Essen, Essen, Germany
| | - Andreas Paul
- Department of General, Visceral, and Transplantation Surgery, University Medicine Essen, Essen, Germany
| | - Lars Pape
- Department of Pediatrics II, Pediatric Gastroenterology, Hepatology and Liver Transplantation, University Children's Hospital, Essen, Germany
- Department of Pediatrics II, Pediatric Nephrology and Kidney Transplantation, University Children's Hospital Essen, Essen, Germany
| | - Peter F. Hoyer
- Department of Pediatrics II, Pediatric Gastroenterology, Hepatology and Liver Transplantation, University Children's Hospital, Essen, Germany
- Department of Pediatrics II, Pediatric Nephrology and Kidney Transplantation, University Children's Hospital Essen, Essen, Germany
| | - Elke Lainka
- Department of Pediatrics II, Pediatric Gastroenterology, Hepatology and Liver Transplantation, University Children's Hospital, Essen, Germany
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Chan ACY, Dai WC, Chung PHY, She WH, Sin SL. The 'Unsigned highway': An alternative route for portal vein anastomosis for non-malignant portal vein thrombosis during pediatric re-transplantation. Hepatobiliary Pancreat Dis Int 2021; 20:193-195. [PMID: 33020033 DOI: 10.1016/j.hbpd.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/15/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Albert Chi Yan Chan
- Division of Liver Transplantation, Department of Surgery, The University of Hong Kong, Hong Kong, China.
| | - Wing Chiu Dai
- Division of Liver Transplantation, Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - Patrick Ho Yu Chung
- Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - Wong Hoi She
- Division of Liver Transplantation, Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - Sui Ling Sin
- Division of Liver Transplantation, Department of Surgery, The University of Hong Kong, Hong Kong, China
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The Largest Single Center Report on Pediatric Liver Transplantation: Experiences and Lessons Learned. Ann Surg 2021; 273:e70-e72. [PMID: 32541224 DOI: 10.1097/sla.0000000000004047] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We described our experiences on pediatric liver transplantation (LT) from the largest LT center in the world termed the Shiraz Transplant Center. BACKGROUND After the first successful pediatric LT in 1967, pediatric LT has become the routine treatment for children with liver failure worldwide. METHODS Data on a total of 1141 pediatric cases of LT were collected. Specifics on baseline and anthropometric characteristics, clinicopathology, prognosis of recipients of LT, and donor characteristics are reported. RESULTS Mean age of patients was 7.83 ± 5.55 years old. Most common etiologies for LT were biliary atresia (15.9%), progressive familial intrahepatic cholestasis (13.4%), and Wilson's disease (13.3%), respectively.Whole organs, living donor grafts, and split grafts were used in 47.9%, 41%, and 11.1% of patients, respectively. In-hospital complications were seen among 34.7% of patients and the most common complications were infections (26.8%), bleeding (23.4%), and vascular complications (18%).Median (interquartile range) model for end stage liver disease score was 20 (15, 25). Main causes of death among patients were sepsis (35.2%), followed by post-transplantation lymphoproliferative diseases (10.5%), and primary nonfunction of liver (9%).Patient survival showed improvement over the years (1-year survival of 73.1%, 83.4%, and 84.4%, 2-year survival of 65.2%, 77.1%, and 78.7%, 5-year survival of 58.2%, 72%, and 77.8% for 1997-2007, 2007-2013, and 2013-2019, respectively; P < 0.001). CONCLUSIONS This is the largest single-center report on pediatric LT in literature which provides valuable experiences in pediatric LT.
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Pediatric Liver Transplantation in a Center That is Neither East Nor West. Ann Surg 2021; 273:e73-e74. [PMID: 33201127 DOI: 10.1097/sla.0000000000004525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Outcomes of Pediatric Liver Transplantation in Japan: A Report from the Registry of the Japanese Liver Transplantation Society (JLTS). Transplantation 2021; 105:2587-2595. [PMID: 33982916 DOI: 10.1097/tp.0000000000003610] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Japanese Liver Transplantation Society (JLTS), a cooperative research consortium, was established in 1980 in order to characterize and follow trends in patient characteristics and graft survival among all liver transplant patients in Japan. This study analyzed factors that may affect the current outcomes of pediatric patients who undergo LT by evaluating one of the largest pediatric LT cohorts in the world. METHODS Between November 1989 and December 2018, 3347 pediatric patients underwent LT in Japan. The survival outcomes of each donor and recipient variant were evaluated. RESULTS The procedures performed during the study period included living donor LT (LDLT; n=3271), deceased donor LT (DDLT; n=69), and domino LT (n=7). There were 1510 male (45.1%) and 1837 female (54.9%) recipients with a median age of 1.7 years (range: 9 days to17.9 years). The graft survival rates at 1, 10, 20, and 30 years were 88.9%, 82.2%, 77.1%, and 75.4%, respectively. Donor age, donor BMI, blood type incompatibility, recipient age, etiology of liver disease, transplant type, center experience, and transplant era were found to be significant predictors of overall graft survival. LDLT is a major treatment modality for end-stage liver disease in children; DDLT and domino LT were applied as alternative treatments for LDLT in patients with specific pediatric liver diseases that are considered to have a poor prognosis following LDLT. CONCLUSIONS Satisfactory long-term pediatric patient survival outcomes were achieved in the JLTS series, and we should continue to promote the deceased donor organ transplantation program in Japan.
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Pandey Y, Varma S, Chikkala BR, Acharya R, Verma S, Balradja I, Das D, Dey R, Agarwal S, Gupta S. Outcome of Pediatric Liver Transplants in Patients With Less Than 10 kg of Body Weight Is Not Worse. EXP CLIN TRANSPLANT 2020; 18:707-711. [PMID: 33187463 DOI: 10.6002/ect.2020.0308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Liver transplant in pediatric patients with body weight < 10 kg poses a challenge to the entire liver transplant team. Many reports have considered 10 kg to be a cutoff pointfor body weightforfavorable posttransplant outcomes. With evolving surgical techniques and postoperative management, there is potential to improve outcomes in this subset of recipients. We compared the outcomes in pediatric patients with body weight < 10 kg with those > 10 kg; also, we studied the factors of influence. MATERIALS AND METHODS We performed a retrospective analysis to evaluate the outcomes of liver transplants in pediatric patients with < 10 kg body weight. The cohort consisted of 90 children subdivided into the following 2 subgroups: group A (n = 35) with > 10 kg body weight at liver transplant and group B (n = 55) with < 10 kg body weight at liver transplant. We compared the following pretransplant characteristics between the groups: graft weight, graft-to-recipient weightratio, cold ischemia time, warm ischemia times, and liver transplant outcomes. RESULTS Pediatric End-stage Liver Disease score was significantly higher in group B (score of 24) versus group A (score of 18). Group B had significantly higher graft-to-recipient weight ratio (2.8 in group B vs 1.7 in group A). Graft function showed no significant difference between the 2 groups. Portal vein thrombosis was seen only in group B, whereas biliary leaks were observed among 5 patients in group B and 1 patientin group A. Patient survivalrate was higherin group B (86%) than in group A (77%). CONCLUSIONS Pediatric patients weighing < 10 kg have similarif not better survivalrates after liver transplant compared with patients > 10 kg. Advancements in surgical techniques and a careful monitoring for complications and timely intervention are important to facilitate these outcomes.
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Affiliation(s)
- Yuktansh Pandey
- From the Centre for Liver and Biliary Sciences, Max Super Speciality Hospital, Saket, New Delhi, India
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38
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Hyponatremia Is Associated With Increased Mortality in Children on the Waiting List for Liver Transplantation. Transplant Direct 2020; 6:e604. [PMID: 33134484 PMCID: PMC7591120 DOI: 10.1097/txd.0000000000001050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/21/2022] Open
Abstract
Our aim was to determine whether hyponatremia is associated with waiting list or posttransplantation mortality in children having liver transplantation (LT).
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39
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Vock DM, Kuehne A, Northrop EF, Matas AJ, Larson Nath C, Chinnakotla S. Pediatric retransplantation of the liver: A prognostic scoring tool. Pediatr Transplant 2020; 24:e13775. [PMID: 32794255 DOI: 10.1111/petr.13775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/13/2020] [Accepted: 06/02/2020] [Indexed: 11/28/2022]
Abstract
Few prognostic models have been created in children that receive liver retransplantation (rLT). We examined the SRTR database of 731 children that underwent second liver transplant between 2002 and 2018. Proportional hazards models using backward variable selection were used to identify recipient, donor, and surgical characteristics associated with survival. A simple prognostic scoring system or nomogram (ie, each risk factor was weighted on a five-point scale) was constructed based on the fitted model. Recipient age (P < .001), MELD/PELD (P < .001), recipient ventilated (P = .003), donor cause of death (P = .024), graft type (P = .045), first graft loss due to biliary tract complications (P = .048), and survival time of the first graft (P = .006) were significant predictors of retransplant survival. The bias-corrected Harrell's C-index for the multivariable model was 0.63. Survival was significantly different (P < .001) for those at low risk (0-4 points), medium risk (5-7 points), and high risk (8+ points). Survival was equivalent between low risk pediatric second transplant recipients and pediatric primary liver transplant recipients (P = .67) but significantly worse for medium- (P < .001) and high-risk (P < .001) recipients. With simple clinical characteristics, this scoring tool can modestly discriminate between those children at high risk and those children at low risk of poor outcomes after second liver transplant.
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Affiliation(s)
- David M Vock
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Alexander Kuehne
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Elise F Northrop
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Arthur J Matas
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | | | - Srinath Chinnakotla
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA.,Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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40
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A Multicenter Japanese Survey Assessing the Long-term Outcomes of Liver Retransplantation Using Living Donor Grafts. Transplantation 2020; 104:754-761. [PMID: 31568214 DOI: 10.1097/tp.0000000000002958] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Liver transplantation is the most suitable treatment option available for end-stage liver disease. However, some patients require retransplantation, despite medical advances that have led to improved survival. We aimed to compile a definitive, nationwide resource of liver retransplantation data in Japan, seeking to identify the predictors of patient survival posttransplantation. METHODS Questionnaires were sent to 32 institutions that had conducted 281 retransplantations before 2015. RESULTS Among the 265 patients included in this study (142 pediatric cases), the average age at primary transplantation was 23 years, and retransplantation was performed after an average of 1468 days. The main indication for retransplantation was graft rejection (95 patients). Living-donor liver transplantation accounted for 94.7% of primary transplantations and 73.2% of retransplantations. Patient survival at 1, 3, or 5 years did not differ by type of transplantation but was better for pediatric (70.8%, 68.3%, and 60.1%, respectively) than for adult (57.2%, 50.4%, and 45.2%, respectively) recipients (P = 0.0003). Small-for-size syndrome, retransplantation within 365 days, and inpatient status at retransplantation were significant predictors of poor survival in pediatric cases. Retransplantation within 365 days and conditions warranting retransplantation were significant predictors of poor survival in adult patients. CONCLUSIONS In Japan, where >70% of retransplantations are performed using living donors, the indications and timing are different from those in previous reports from other countries, while maintaining comparable survival rates. Considering technical challenges, graft failure within 365 days should be thoroughly restricted to justify the use of living donor.
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Oswari H, Rahayatri TH, Soedibyo S. Pediatric Living Donor Liver Transplant in Indonesia's National Referral Hospital. Transplantation 2020; 104:1305-1307. [PMID: 32568998 DOI: 10.1097/tp.0000000000003154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Hanifah Oswari
- Department of Child Health, Gastrohepatology Division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Tri Hening Rahayatri
- Department of Surgery, Pediatric Surgery Division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Sastiono Soedibyo
- Department of Surgery, Pediatric Surgery Division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Gomez VW, Buell ER, Yang G, Ding L, Aronson LA. Hypothermia during pediatric liver transplantation with intraoperative continuous renal replacement therapy: A retrospective study. J Clin Anesth 2020; 66:109912. [PMID: 32480205 DOI: 10.1016/j.jclinane.2020.109912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/06/2020] [Accepted: 05/22/2020] [Indexed: 01/10/2023]
Affiliation(s)
- Vera Winograd Gomez
- Cincinnati Children's Hospital and Medical Center, Department of Anesthesia, 3333 Burnet Ave-MLC 2001, Cincinnati, OH 45229-3039, USA
| | - Eric R Buell
- Cincinnati Children's Hospital and Medical Center, Department of Anesthesia, 3333 Burnet Ave-MLC 2001, Cincinnati, OH 45229-3039, USA
| | - Gang Yang
- Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology, Department of Pediatrics, 3333 Burnet Ave-MLC 5041, Cincinnati, OH 45229-3039, USA
| | - Lili Ding
- Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology, Department of Pediatrics, 3333 Burnet Ave-MLC 5041, Cincinnati, OH 45229-3039, USA
| | - Lori A Aronson
- Cincinnati Children's Hospital and Medical Center, Department of Anesthesia, 3333 Burnet Ave-MLC 2001, Cincinnati, OH 45229-3039, USA.
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Kirchner VA, Goldaracena N, Sapisochin G, Alejandro RH, Shah SA. Current status of liver transplantation in North America. Int J Surg 2020; 82S:9-13. [PMID: 32473238 DOI: 10.1016/j.ijsu.2020.05.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 12/22/2022]
Abstract
Liver transplantation is continuing to grow and evolve in North America. Changes in organ availability, recipient selection, indications and progressive approaches to oncologic treatment have occurred in the last five years. Despite increased activity in deceased and living donation in North America, there continues to be a high mortality on the waitlist as the recipient indications have changed over time which has led to new approaches to help patients with end-stage liver disease.
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Affiliation(s)
| | | | | | | | - Shimul A Shah
- Department of Surgery, University of Cincinnati College of Medicine, USA.
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Improved Outcomes for Liver Transplantation in Patients with Biliary Atresia Since Pediatric End-Stage Liver Disease Implementation: Analysis of the Society of Pediatric Liver Transplantation Registry. J Pediatr 2020; 219:89-97. [PMID: 32005543 DOI: 10.1016/j.jpeds.2019.12.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/14/2019] [Accepted: 12/12/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify changes in demographics, outcomes, and risk factors for patient and graft loss in patients with biliary atresia undergoing liver transplantation since Pediatric End-Stage Liver Disease implementation (2002). STUDY DESIGN Demographics and outcomes were compared between patients enrolled in the Society of Pediatric Liver Transplantation registry before (n = 547) and after (n = 1477) 2002. Kruskal-and χ2 Wallis tests identified significant differences between eras. Risk factors for patient and graft loss after 2002 were determined by Cox regression model analysis of time to event data. RESULTS Significant patient differences after 2002 support increasing disease severity including more status 1 patients and those with a derived Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease score of greater than 30 awaiting transplant. Both patient and graft survival improved after 2002 from 90% to 97% and 81% to 90%, respectively (primary transplant; P < .0001). Significant differences in complications within 30 days included reduced relisting for transplant, rejection, culture-positive infection, repeat operation, hepatic artery thrombosis, portal vein thrombosis, and death/transplant before discharge. Multivariable analysis identified deceased technical variant vs whole graft and retransplantation predictive for patient death, hazard ratios of 4.041 and 8.308, respectively. Deceased technical variant vs whole graft (hazard ratio, 1.963) and donor age 0-5 months vs 1-17 years (hazard ratio, 5.525) were risk factors for graft loss. CONCLUSIONS The overall outcomes of patients receiving liver transplantation for patients with biliary atresia have improved since 2002 despite evidence of increased disease severity at the time of transplant. Risk factors impacting post-transplant morbidity and mortality in patients with biliary atresia are now mainly surgical including donor variables.
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Cañon Reyes I, Halac E, Aredes D, Lauferman L, Cervio G, Dip M, Minetto J, Reijenstein H, Meza V, Gole M, Jacobo Dillon A, Imventarza O. Prognostic Factors in Pediatric Early Liver Retransplantation. Liver Transpl 2020; 26:528-536. [PMID: 31965712 DOI: 10.1002/lt.25719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/01/2020] [Indexed: 02/07/2023]
Abstract
The most common indications for early liver retransplantation (eRe-LT) are vascular complications and primary nonfunction (PNF). These patients are usually in a critical clinical condition that can affect their chances of survival. In fact, the survival of these patients is usually lower compared with the patients undergoing a first transplant. To the best of our knowledge, no specific series of pediatric patients undergoing eRe-LT has been published to date. Therefore, the aim of this study is to report the results of eRe-LT and to analyze factors potentially related to success or failure. Our work is of a retrospective cohort study of patients who underwent eRe-LT at the Juan P. Garrahan Pediatric Hospital of Buenos Aires, Argentina, between May 1995 and December 2018 (n = 60). Re-LT was considered early when performed ≤30 days after the previous LT. A total of 40 (66.7%) patients were enrolled due to vascular causes and 20 (33.3%) were enrolled because of PNF. Of all the relisted patients, 36 underwent eRe-LT, 14 died on the waiting list, and 10 recovered without eRe-LT. A total of 23 (63.9%) patients died after eRe-LT, most of them due to infection-related complications. Survival rates at 1 and 5 years were 42.4% and 33.9%, respectively. On univariate logistic regression analysis, Pediatric End-Stage Liver Disease (PELD)/Model for End-Stage Liver Disease (MELD) scores, transplant era, and advanced life support at eRe-LT were found to be related to 60-day mortality. However, on multivariate analysis, era (odds ratio [OR], 9.3; 95% confidence interval [CI], 1.19-72.35; P = 0.033) and PELD/MELD scores (OR, 1.07; 95% CI, 1-1.14; P = 0.036) were significantly associated with 60-day patient mortality. This study found that the level of acuity before retransplant, measured by the requirement of advanced life support and the PELD/MELD score at eRe-LT, was significantly associated with the chances of post-eRe-LT patient survival.
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Affiliation(s)
- Isabel Cañon Reyes
- Department of Pediatric Liver Transplant, Hospital de Pediatria Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Esteban Halac
- Department of Pediatric Liver Transplant, Hospital de Pediatria Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Diego Aredes
- Department of Pediatric Liver Transplant, Hospital de Pediatria Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Leandro Lauferman
- Department of Pediatric Liver Transplant, Hospital de Pediatria Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Guillermo Cervio
- Department of Pediatric Liver Transplant, Hospital de Pediatria Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Marcelo Dip
- Department of Pediatric Liver Transplant, Hospital de Pediatria Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Julia Minetto
- Department of Pediatric Liver Transplant, Hospital de Pediatria Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Hayellen Reijenstein
- Department of Pediatric Liver Transplant, Hospital de Pediatria Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Veronica Meza
- Department of Pediatric Liver Transplant, Hospital de Pediatria Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Maria Gole
- Department of Pediatric Liver Transplant, Hospital de Pediatria Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Agustina Jacobo Dillon
- Department of Pediatric Liver Transplant, Hospital de Pediatria Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Oscar Imventarza
- Department of Pediatric Liver Transplant, Hospital de Pediatria Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
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Projected 20- and 30-Year Outcomes for Pediatric Liver Transplant Recipients in the United States. J Pediatr Gastroenterol Nutr 2020; 70:356-363. [PMID: 31880667 PMCID: PMC8573715 DOI: 10.1097/mpg.0000000000002592] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Observed long-term outcomes no longer reflect the survival trajectory facing pediatric liver transplant (LT) recipients today. We aimed to use national registry data and parametric models to project 20- and 30-year post-transplant outcomes for recently transplanted pediatric LT recipients. METHODS We conducted a retrospective cohort study of 13,442 first-time pediatric (age <18) LT recipients using 1987 to 2018 Scientific Registry of Transplant Recipients data. We validated the proposed method (ie, to project long-term patient and graft survival using parametric survival models and short-term data) in 2 historic cohorts (1987-1996 and 1997-2006) and estimated long-term projections among patients transplanted between 2007 and 2018. Projections were stratified by raft type, recipient age, and indication for transplant. RESULTS Parsimonious parametric models with Weibull distribution can be applied to post-transplant data and used to project long-term outcomes for pediatric LT recipients beyond observed data. Projected 20-year patient survival for pediatric LT recipients transplanted in 2007 to 2018 was 84.0% (95% confidence interval 81.5-85.8), compared to observed 20-year survival of 72.8% and 63.6% among those transplanted in 1997 to 2006 and 1987 to 1996, respectively. Projected 30-year survival for pediatric LT recipients in 2007 to 2018 was 80.1% (75.2-82.7), compared to projected 30-year survival of 68.6% (66.1-70.9) in the 1997 to 2006 cohort and observed 30-year survival of 57.5% in the 1987 to 1996 cohort. Twenty- and 30-year patient and graft survival varied slightly by recipient age, graft type, and indication for transplant. CONCLUSIONS Projected long-term outcomes for recently transplanted pediatric LT recipients are excellent, reflective of substantial improvements in medical care, and informative for physician-patient education and decision making in the current era.
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Tran LT, Carullo PC, Banh DPT, Vitu C, Davis PJ. Pediatric Liver Transplantation: Then and Now. J Cardiothorac Vasc Anesth 2020; 34:2028-2035. [PMID: 32241678 DOI: 10.1053/j.jvca.2020.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/11/2020] [Indexed: 12/20/2022]
Abstract
This paper reviews the past 50 years of liver transplantation in children from the perspective of patient demographics, perioperative patient management, surgical techniques, immunosuppression and patient outcomes.
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Affiliation(s)
- Lieu T Tran
- Department of Pediatric Anesthesiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Philip C Carullo
- Department of Pediatric Anesthesiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Diem Phuc T Banh
- Department of Pediatric Anesthesiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Chelsea Vitu
- Department of Pediatric Anesthesiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Peter J Davis
- Department of Pediatric Anesthesiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
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Goldaracena N, Echeverri J, Kehar M, DeAngelis M, Jones N, Ling S, Kamath BM, Avitzur Y, Ng VL, Cattral MS, Grant DR, Ghanekar A. Pediatric living donor liver transplantation with large-for-size left lateral segment grafts. Am J Transplant 2020; 20:504-512. [PMID: 31550068 DOI: 10.1111/ajt.15609] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/26/2019] [Accepted: 09/03/2019] [Indexed: 02/07/2023]
Abstract
Usage of "large-for-size" left lateral segment (LLS) liver grafts in children with high graft to recipient weight ratio (GRWR) is controversial due to concerns about increased recipient complications. During the study period, 77 pediatric living donor liver transplantations (LDLTs) with LLS grafts were performed. We compared recipients with GRWR ≥2.5% (GR-High = 50) vs GRWR <2.5% (GR-Low = 27). Median age was higher in the GR-Low group (40 vs 8 months, P> .0001). Graft (GR-High: 98%, 98%, 98% vs GR-Low: 96%, 93%, 93%) and patient (GR-High: 98%, 98%, 98% vs GR-Low: 100%, 96%, 96%) survival at 1, 3, and 5 years was similar between groups (P = NS). Overall complications were also similar (34% vs 30%; P = .8). Hepatic artery and portal vein thrombosis following transplantation was not different (P = NS). Delayed abdominal fascia closure was more common in GR-High patients (17 vs 1; P = .002). Subgroup analysis comparing recipients with GRWR ≥4% (GR-XL = 20) to GRWR <2.5% (GRWR-Low = 27) revealed that delayed abdominal fascia closure was more common in the GR-XL group, but postoperative complications and graft and patient survival were similar. We conclude that pediatric LDLT with large-for-size LLS grafts is associated with excellent clinical outcomes. There is an increased need for delayed abdominal closure with no compromise of long-term outcomes. The use of high GRWR expands the donor pool and improves timely access to the benefits of transplantation without extra risks.
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Affiliation(s)
- Nicolas Goldaracena
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, University Health Network, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada.,Division of Transplant Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Juan Echeverri
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, University Health Network, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Mohit Kehar
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada.,Liver Transplant Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maria DeAngelis
- Liver Transplant Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicola Jones
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada.,Liver Transplant Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Simon Ling
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada.,Liver Transplant Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Binita M Kamath
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada.,Liver Transplant Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yaron Avitzur
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada.,Liver Transplant Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vicky L Ng
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada.,Liver Transplant Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark S Cattral
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, University Health Network, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada.,Liver Transplant Program, Hospital for Sick Children, Toronto, Ontario, Canada.,Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - David R Grant
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, University Health Network, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada.,Liver Transplant Program, Hospital for Sick Children, Toronto, Ontario, Canada.,Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anand Ghanekar
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, University Health Network, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada.,Liver Transplant Program, Hospital for Sick Children, Toronto, Ontario, Canada.,Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
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Ruiz MM, Alobaidi R, Noga ML, Featherstone R, Shapiro J, Bhargava R. Doppler ultrasound values after liver transplantation in children and their association with graft outcomes: a protocol for a systematic review and meta-analysis. BMJ Open 2019; 9:e033887. [PMID: 31826898 PMCID: PMC6924843 DOI: 10.1136/bmjopen-2019-033887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Liver graft and patient survival in children have improved substantially over the years; nevertheless, graft-related complications persist as the most important risk factor for mortality and graft loss. Doppler ultrasound evaluation is routinely used after liver transplantation; however, there is no consensus defining normal values, timing or frequency of Doppler ultrasound postoperative evaluation. Identification of patients who require an intervention or change in postoperative management is therefore challenging. METHODS AND ANALYSIS We will conduct a systematic review and meta-analysis to appraise and synthesise evidence describing Doppler ultrasound measurements and their association with graft complications in children who have received a liver transplant. We will search multiple databases: Ovid Medline, Embase, Wiley Cochrane Library, Web of Science-Science Citation Index Expanded, trial registry records and meeting abstracts using a combination of subject headings and keywords for liver transplantation, Doppler ultrasound and paediatric patients. All identified titles and abstracts of studies will be assessed for potential relevance. Selected studies will be retrieved and subjected to a second phase of screening, both selection phases will be done in duplicate by two independent reviewers, and discrepancies will be documented and resolved by a third reviewer. Data extraction will be done independently by two reviewers using a standardised data extraction form. Quality of evidence and risk of bias will be assessed, synthesised and pooled for meta-analysis if possible. We will perform a subgroup analysis if enough data are available. ETHICS AND DISSEMINATION Strategies to disseminate our review include presenting in liver transplant review sessions, publishing in high-impact peer-reviewed medical journals, and presenting at national and international paediatric radiology and liver transplant meetings, conference presentations, events, courses and plain-language summaries. This knowledge will allow easier identification of patients with a higher risk of developing graft-related complications and could potentially improve patient and graft outcomes. We wish to disseminate our results to discover potential areas for future research and drive improved future practices and policies. Our target audience includes researchers, institutions, healthcare professionals, health system decision-makers, policy-makers and research funders community. TRIAL REGISTRATION NUMBER CRD42019119986.
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Affiliation(s)
- Martha M Ruiz
- Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Rashid Alobaidi
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Lisa Noga
- Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | | | - James Shapiro
- Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Ravi Bhargava
- Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
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Short- and Long-Term Outcomes After Live-Donor Transplantation with Hyper-Reduced Liver Grafts in Low-Weight Pediatric Recipients. J Gastrointest Surg 2019; 23:2411-2420. [PMID: 30887299 DOI: 10.1007/s11605-019-04188-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/26/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate short- and long-term outcomes after live-donor liver transplantation (LT) with hyper-reduced grafts in low-weight pediatric recipients. LT is an established curative therapy for children with end-stage chronic liver disease or acute liver failure. A major problem in pediatric LT has been the lack of size-matched donor organs. The disadvantage of the use of large-for-size grafts is the insufficient tissue oxygenation and graft compression, which result in poor outcomes. The shortage of suitable donors is most notable in children under 10 kg. To overcome such obstacle, in situ hyper-reduced live-donor liver grafts have been introduced. Available articles in the literature are based on small samples and are deficient in long-term follow-up. METHODS A single-cohort, retrospective analysis was conducted including 59 pediatric patients under 10 kg who underwent hyper-reduced (in situ "a la carte" left lateral segment reduction) live-donor LT (LDLT) between February 1994 and February 2018. RESULTS The most frequent cause of liver failure was biliary atresia (70%). Median recipient weight was 8 kg. Vascular complications were confirmed in 15% of the sample, while 45% presented biliary complications. Median follow-up time was 40.3 months. Ten-year overall survival rate was 74%. Pediatric end-stage liver disease score > 23 was associated with a higher risk of post-operative complications. CONCLUSION LDLT can be undertaken in children with body weight < 10 kg achieving good results in high-volume centers by experienced surgeons.
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