One Hundred Thirty-Two Consecutive Pediatric Liver Transplants Without Hospital Mortality: Lessons Learned and Outlook for the Future

[Guest guest]

December 2004, 240:6

One Hundred Thirty-Two Consecutive Pediatric Liver Transplants Without

Hospital Mortality: Lessons Learned and Outlook for the Future.

ls of Surgery. 240(6):1002-1012, December 2004.

Broering, Dieter C. MD *; Kim, Jong-Sun MD *; Mueller, *; Fischer,

Lutz PhD *; Ganschow, Rainer PhD +; Bicak, Turan *; Mueller, Lars MD *;

Hillert, Christian MD *; Wilms, Christian *; Hinrichs, Bernd MD +; Helmke,

Knut PhD ++; Pothmann, Werner MD ; Burdelski, PhD +; Rogiers,

Xavier PhD *

Abstract:

Objective: Orthotopic liver transplantation (OLT) has become an established

procedure for the treatment of pediatric patients with end-stage liver

disease. Since starting our program in 1989, 422 pediatric OLTs have been

performed using all techniques presently available. Analyzing our series, we

have concluded that the year of transplantation is the most important

prognostic factor in patient and graft survival in a multivariate analysis.

Methods: From April 2001 to December 1, 2003, 18 whole organs (14%), 17

reduced-size organs (13%), 53 split organs (42%; 46 ex situ, 7 in situ), and

44 organs from living donors (33%) were transplanted into 115 patients (62

male and 53 female). One hundred twelve were primary liver transplants, 18

were retransplants, one third and one fourth liver transplants. Of the 132

OLTs, 26 were highly urgent (19.7%). The outcome of these 132 OLTs was

retrospectively analyzed.

Results: Of 132 consecutive pediatric liver transplants, no patients died

within the 6 months posttransplantation. Overall, 3 recipients (2%) died

during further follow-up, 1 child because of severe pneumonia 13 months

after transplantation and the second recipient with unknown cause 7 months

postoperatively, both with good functioning grafts after uneventful

transplantation. The third had a recurrence of an unknown liver disease 9

months after transplantation. The 3-month and actual graft survival rates

are 92% and 86%, respectively. Sixteen children (12%) had to undergo

retransplantation, the causes of which were chronic rejection (3.8%),

primary nonfunction (3.8%), primary poor function (PPF; 1.5%), and arterial

thrombosis (3%). The biliary complication rate was 6%; arterial

complications occurred in 8.3%; intestinal perforation was observed in 3%;

and in 5%, postoperative bleeding required reoperation. The portal vein

complication rate was 2%.

Conclusions: Progress during the past 15 years has enabled us to perform

pediatric liver transplantation with near perfect patient survival. Advances

in posttransplant care of the recipients, technical refinements,

standardization of surgery and monitoring, and adequate choice of the donor

organ and transplantation technique enable these results, which mark a

turning point at which immediate survival after transplantation will be

considered the norm. The long-term treatment of the transplanted patient,

with the aim of avoiding late graft loss and achieving optimal quality of

life, will become the center of debate.