Italian experience of pediatric liver transplantation

Abstract

The SIGENP Group has created an Italian Liver Transplantation database. The study considers all patients under 18 yr of age on the waiting list or transplanted between 1984 and 2005. Demographic and clinical data were collected and a descriptive analysis was conducted. Kaplan-Meier survival curves were calculated and Cox's proportional-hazards regression analysis were performed to identify predictors of death after transplantation. Twenty-two Italian centers took part and data were collected on 622 cases: only 53.8% of the transplants performed up until 1998 were carried out in Italy, while this was true of 97.7% of the operations performed between 1999 and 2005. Recipient survival curve analysis revealed one-, two- and five-yr survival rates of 88, 87 and 84%, respectively, and a significant improvement in survival after 1998 (p = 0.0322). Cox's analysis identified the following risk factors for death after liver transplantation, i.e. transplantation before 1998, neoplasms or fulminant hepatic failure as indications, being in intensive care at the time of transplantation and retransplantation. The center where the transplant is performed also revealed an influence on patient survival. Thanks to a better patient follow-up and more cooperation between specialists, the mean survival after liver transplantation is improving and Italian children can be transplanted in Italy.

The current status of pediatric liver transplantation in Mainland China

“…Pediatric liver transplantation accounts only for 2.3% (337/14 926) of all the liver transplantation enrolled in CLTR. The percentage of pediatric cases is obviously smaller than that reported in the US and Europe (4–6), where it is around 10%. Likewise, the distributions of age and primary disease also differ significantly.…”

“…Likewise, the distributions of age and primary disease also differ significantly. In Mainland China, the most common indication is Wilson’s disease, and most children are transplanted at a relatively late stage of childhood (>7 yr), whereas in US and Europe (4–6), biliary atresia accounted for around 50% of pediatric liver transplantation, and the majority of recipients are transplanted at age <3 yr. All the above suggest poor acceptance of liver transplantation by Chinese family, especially in a very early period of childhood. While many parents accept the Kasai procedure, which is performed in many hospitals, very few parents would choose liver transplantation when the native liver is failed.…”

Pediatric Organ Transplantation and Risk of Premalignant and Malignant Tumors in Sweden

“…Though there are some published descriptive reports and case series about malignancies in pediatric organ transplant patients (7–9), most have not assessed the association between transplantation and risk of future cancer relative to baseline rates, and most have had a limited follow‐up time. In the present study, we assessed risk of first incident malignant and premalignant tumors in a cohort of 536 pediatric organ transplant recipients (transplanted before the age of 18) in comparison with the general population, using up to 36 years of follow‐up posttransplant in Sweden.…”

Pediatric liver transplantation in Hong Kong—a domain with scarce deceased donors

“…The 1-year patient survival rate for pediatric LT patients varies in different reports from 77% to 99% [17][18][19], depending on the length of clinical review. In recent years, retransplantation owing to technical reasons has been dwindling [19] and the successful rate of LT has been improving with time.…”